TABLE 1.
Demographics and Clinical Characteristics of Patients With NAFLD/NASH by Liver Disease Severity Stage
| Liver Disease Severity Stage‡ | ||||||
|---|---|---|---|---|---|---|
| Demographics and Clinical Characteristics | NAFLD/NASH Without AdvLD (N=453,564) | NAFLD/NASH§ (N=468,017) | CC (N=7665) | DCC (N=15,833) | LT (N=696) | HCC (N=428) |
| Demographics | ||||||
| Age [mean (SD)] (y) | 47.6 (10.9) | 47.7 (10.8) | 50.7 (9.9)* | 51.4 (10.2)*† | 51.7 (9.9)*† | 51.5 (9.8)* |
| Age group [n (%)] (y) | ||||||
| <45 | 163,860 (36.1) | 167,157 (35.7) | 1853 (24.2) | 3653 (7.7) | 135 (19.4) | 82 (19.2) |
| 45-54 | 146,893 (32.4) | 151,661 (32.4) | 2547 (33.2) | 4682 (29.6) | 227 (32.6) | 148 (34.6) |
| 55-64 | 142,811 (31.5) | 149,199 (31.9) | 3265 (42.6) | 7498 (47.4) | 334 (48.0) | 198 (46.3) |
| Gender [n (%)] | ||||||
| Female | 240,856 (53.1) | 249,313 (53.3) | 4472 (58.3)* | 9169 (57.9)* | 384 (55.2) | 226 (52.8)† |
| Geographic region [n (%)] | ||||||
| Northeast | 74,806 (16.5) | 77,139 (16.5) | 1017 (13.3)* | 2503 (15.8)*† | 98 (14.1) | 92 (21.5)*† |
| North Central | 87,638 (19.3) | 90,779 (19.4) | 1749 (22.8) | 3327 (21.0) | 157 (22.6) | 69 (16.1) |
| South | 203,722 (44.9) | 210,444 (45.0) | 3685 (48.1) | 7500 (47.4) | 319 (45.8) | 187 (43.7) |
| West | 80,611 (17.8) | 82,680 (17.7) | 1069 (13.9) | 2321 (14.7) | 115 (16.5) | 78 (18.2) |
| Unknown | 6787 (1.5) | 6975 (1.5) | 145 (1.9) | 182 (1.1) | 7 (1.0) | 2 (0.5) |
| Insurance plan type [n (%)] | ||||||
| Comprehensive/Indemnity | 10,393 (2.3) | 10,949 (2.3) | 232 (3.0)* | 603 (3.8)*† | 28 (4.0)*† | 11 (2.6) |
| EPO/PPO | 282,584 (62.3) | 291,538 (62.3) | 4856 (63.4) | 9854 (62.2) | 413 (59.3) | 281 (65.7) |
| POS with or without capitation | 34,423 (7.6) | 35,803 (7.6) | 593 (7.7) | 1302 (8.2) | 51 (7.3) | 29 (6.8) |
| HMO | 60,634 (13.4) | 62,442 (13.3) | 884 (11.5) | 1679 (10.6) | 85 (12.2) | 50 (11.7) |
| CDHP/HDHP | 43,832 (9.7) | 45,011 (9.6) | 696 (9.1) | 1749 (11.0) | 89 (12.8) | 38 (8.9) |
| Unknown | 21,698 (4.8) | 22,274 (4.8) | 404 (5.3) | 646 (4.1) | 30 (4.3) | 19 (4.4) |
| Clinical Characteristics | ||||||
| DCCI [mean (SD)] | 0.47 (1.02) | 0.49 (1.06) | 1.07 (1.43)* | 1.52 (2.35)*† | 2.53 (2.82)*† | 2.59 (3.28)*† |
| Comorbidities [n (%)]‖ | ||||||
| Abdominal pain | 154,157 (34.0) | 159,277 (34.0) | 2879 (37.6)* | 6830 (43.1)*† | 400 (57.5)*† | 218 (50.9)*† |
| Anemia | 26,176 (5.8) | 27,831 (5.9) | 910 (11.9)* | 3215 (20.3)*† | 170 (24.4)*† | 76 (17.8)*† |
| CVD | 236,913 (52.2) | 246,397 (52.6) | 5067 (66.1)* | 10,585 (66.9)* | 448 (64.4)* | 267 (62.4)* |
| Fatigue/insomnia | 58,246 (12.8) | 60,531 (12.9) | 1114 (14.5)* | 2997 (18.9)*† | 116 (16.7)* | 60 (14.0) |
| HTN | 163,389 (36.0) | 169,776 (36.3) | 3710 (48.4)* | 7945 (50.2)*† | 348 (50.0)* | 209 (48.8)* |
| Hyperlipidemia | 162,376 (35.8) | 167,934 (35.9) | 3417 (44.6)* | 6290 (39.7)*† | 259 (37.2)† | 170 (39.7)† |
| Obesity | 63,802 (14.1) | 65,956 (14.1) | 1831 (23.9)* | 3568 (22.5)*† | 142 (20.4)*† | 56 (13.1)† |
| PUD, dyspepsia, GERD, esophagitis | 75,370 (16.6) | 78,199 (16.7) | 1823 (23.8)* | 4425 (27.9)*† | 184 (26.4)* | 99 (23.1)* |
| RI | 15,396 (3.4) | 16,200 (3.5) | 433 (5.6)* | 2085 (13.2)*† | 126 (18.1)*† | 52 (12.1)*† |
| Sleep apnea | 45,011 (9.9) | 46,961 (10.0) | 1310 (17.1)* | 2498 (15.8)*† | 70 (10.1)† | 32 (7.5)† |
| Smoking | 16,498 (3.6) | 17,129 (3.7) | 330 (4.3)* | 1259 (8.0)*† | 53 (7.6)*† | 25 (5.8)* |
| T2DM | 106,683 (23.5) | 111,832 (23.9) | 3525 (46.0)* | 5752 (36.3)*† | 284 (40.8)*† | 160 (37.4)*† |
| Thyroid disease (including hypothyroidism) | 54,648 (12.0) | 56,762 (12.1) | 1290 (16.8)* | 2653 (16.8)* | 112 (16.1)* | 71 (16.6)* |
| Vitamin D deficiency | 30,835 (6.8) | 31,846 (6.8) | 673 (8.8)* | 1447 (9.1)* | 46 (6.6) | 27 (6.3) |
| Comorbidity combinations: HTN, hyperlipidemia, CVD, RI, T2DM [n (%)]‖ | ||||||
| At least 1 condition | 308,442 (68.0) | 319,801 (68.3) | 6315 (82.4)* | 12,721 (80.3)*† | 558 (80.2)* | 337 (78.7)* |
| At least 2 conditions | 215,962 (47.6) | 224,670 (48.0) | 5025 (65.6)* | 9958 (62.9)*† | 448 (64.4)* | 266 (62.1)* |
| At least 3 conditions | 117,783 (26.0) | 122,884 (26.3) | 3231 (42.2)* | 6454 (40.8)*† | 293 (42.1)* | 166 (38.8)* |
‡Demographics and clinical characteristics of patients who progressed to more AdvLD (eg, CC to DCC or DCC to HCC) were determined at each diagnosis (index) of liver disease during the study duration. Therefore, patients with >1 diagnosis of liver disease confirmed during the follow-up period of the study were considered more than once in the table.
§NAFLD/NASH study cohort comprises overall NAFLD/NASH patients until progression to a more severe stage, at which follow-up is censored.
‖Identification of comorbid conditions were based on the presence of ICD-9-CM/ICD-10-CM diagnosis codes during the preindex period. For the identification of CVD, RI, and T2DM, National Drug Codes (NDC) were also utilized (Supporting Table S2, Supplemental Digital Content 1, http://links.lww.com/JCG/A602).
AdvLD indicates advanced liver diseases; CC, compensated cirrhosis; CDHP, consumer driver health plan; CVD, cardiovascular disease; DCC, decompensated cirrhosis; DCCI, Deyo-Charlson Comorbidity Index, EPO, exclusive provider organization; GERD, gastroesophageal reflux disease; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification; HCC, hepatocellular carcinoma; HDHP, high-deductible health plan; HMO, health maintenance organization; HTN, hypertension; LT, liver transplantation; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; POS, point-of-service; PPO, preferred provider organization; PUD, peptic ulcer disease; RI, renal impairment; T2DM, type 2 diabetes mellitus.
*P<0.05 for comparison of CC, DCC, LT, or HCC cohort versus NAFLD/NASH without AdvLD cohort.
†P<0.05 for comparison of DCC, LT, or HCC cohort versus CC cohort.