TABLE 3.
Results of Generalized Linear Model—Total Annual All-cause Health Care Costs (Postindex) Adjusted by Demographics and Clinical Characteristics
| Independent Variables | Cost Ratio | 95% CI (Lower-Upper) | P |
|---|---|---|---|
| Liver disease severity stage | |||
| NAFLD/NASH without AdvLD | Reference | — | — |
| NAFLD/NASH* | 1.02 | 1.02-1.03 | <0.0001 |
| CC | 1.22 | 1.19-1.25 | <0.0001 |
| DCC | 5.64 | 5.53-5.74 | <0.0001 |
| LT | 8.27 | 7.57-9.04 | <0.0001 |
| HCC | 4.09 | 3.65-4.58 | <0.0001 |
| Geographic region | |||
| Northeast | Reference | — | — |
| North Central | 1.17 | 1.16-1.18 | <0.0001 |
| South | 1.11 | 1.11-1.12 | <0.0001 |
| West | 1.07 | 1.06-1.08 | <0.0001 |
| Insurance plan type | |||
| HMO | Reference | — | — |
| Comprehensive/indemnity | 1.13 | 1.11-1.15 | <0.0001 |
| EPO/PPO | 1.14 | 1.14-1.15 | <0.0001 |
| POS with or without capitation | 1.16 | 1.15-1.18 | <0.0001 |
| CDHP/HDHP | 1.14 | 1.13-1.16 | <0.0001 |
| Unknown | 1.04 | 1.03-1.06 | <0.0001 |
| Population density | |||
| Urban | Reference | — | — |
| Rural | 1.07 | 1.06-1.08 | <0.0001 |
| DCCI | 1.27 | 1.26-1.27 | <0.0001 |
| Age groups (y) | |||
| 18-44 | Reference | — | — |
| 45-54 | 1.09 | 1.08-1.09 | <0.0001 |
| 55-64 | 1.17 | 1.17-1.18 | <0.0001 |
| Gender | |||
| Male | Reference | — | — |
| Female | 1.21 | 1.20-1.21 | <0.0001 |
| Comorbidities† | |||
| Abdominal pain | 1.07 | 1.07-1.08 | <0.0001 |
| Anemia | 1.36 | 1.34-1.37 | <0.0001 |
| CVD | 1.10 | 1.09-1.10 | <0.0001 |
| Fatigue/insomnia | 1.10 | 1.09-1.11 | <0.0001 |
| Hypertension | 1.05 | 1.05-1.06 | <0.0001 |
| Hyperlipidemia | 0.82 | 0.81-0.82 | <0.0001 |
| Obesity | 1.52 | 1.51-1.53 | <0.0001 |
| PUD, dyspepsia, GERD, esophagitis | 1.19 | 1.18-1.20 | <0.0001 |
| RI | 1.29 | 1.26-1.33 | <0.0001 |
| Sleep apnea | 1.35 | 1.34-1.36 | <0.0001 |
| Smoking | 1.33 | 1.31-1.35 | <0.0001 |
| Thyroid disease (including hypothyroidism) | 1.01 | 1.00-1.02 | 0.0205 |
| T2DM | 0.91 | 0.90-0.92 | <0.0001 |
| Vitamin D deficiency | 0.98 | 0.97-0.99 | 0.0007 |
| Comorbidity combinations† | |||
| CVD and RI | 0.99 | 0.95-1.02 | 0.4023 |
| CVD and T2DM | 1.09 | 1.07-1.10 | <0.0001 |
| RI and T2DM | 1.16 | 1.09-1.24 | <0.0001 |
| CVD, RI, and DM | 0.81 | 0.76-0.87 | <0.0001 |
| Hypertension, hyperlipidemia, T2DM, CVD, and obesity | 0.95 | 0.93-0.97 | <0.0001 |
*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; CI, confidence interval; CVD, cardiovascular disease; DCC, decompensated cirrhosis; DCCI, Deyo-Charlson Comorbidity Index, EPO, exclusive provider organization; GERD, gastroesophageal reflux disease; HCC, hepatocellular carcinoma; HDHP, high-deductible health plan; HMO, health maintenance organization; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification; 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.