Determinants of Disparities in Early COVID-19 Job Losses

This study examines the sociodemographic divide in early labor market responses to the U.S. COVID-19 epidemic and associated policies, benchmarked against two previous recessions. Monthly Current Population Survey (CPS) data show greater declines in employment in April and May 2020 (relative to February) for Hispanic individuals, younger workers, and those with a high school diploma or some college. Between April and May, the demographic subgroups considered regained some employment. Reemployment in May was broadly proportional to the employment drop that occurred through April, except for Black individuals, who experienced a smaller rebound. Compared to the 2001 recession and the Great Recession, employment losses in the early COVID-19 recession were smaller for groups with low or high (vs. medium) education. We show that job loss was greater in occupations that require more interpersonal contact and that cannot be performed remotely, and that pre-COVID-19 sorting of workers into occupations and industries along demographic lines can explain a sizable portion of the demographic gaps in new unemployment. For example, while women suffered more job losses than men, their disproportionate pre-epidemic sorting into occupations compatible with remote work shielded them from even larger employment losses. However, substantial gaps in employment losses across groups cannot be explained by socioeconomic differences. We consider policy lessons and future research needs regarding the early labor market implications of the COVID-19 crisis.

Determinants of Disparities in Early COVID-19 Job Losses

This study examines the sociodemographic divide in early labor market responses to the U.S. COVID-19 epidemic and associated policies, benchmarked against two previous recessions. Monthly Current Population Survey (CPS) data show greater declines in employment in April and May 2020 (relative to February) for Hispanic individuals, younger workers, and those with a high school diploma or some college. Between April and May, the demographic subgroups considered regained some employment. Reemployment in May was broadly proportional to the employment drop that occurred through April, except for Black individuals, who experienced a smaller rebound. Compared to the 2001 recession and the Great Recession, employment losses in the early COVID-19 recession were smaller for groups with low or high (vs. medium) education. We show that job loss was greater in occupations that require more interpersonal contact and that cannot be performed remotely, and that pre-COVID-19 sorting of workers into occupations and industries along demographic lines can explain a sizable portion of the demographic gaps in new unemployment. For example, while women suffered more job losses than men, their disproportionate pre-epidemic sorting into occupations compatible with remote work shielded them from even larger employment losses. However, substantial gaps in employment losses across groups cannot be explained by socioeconomic differences. We consider policy lessons and future research needs regarding the early labor market implications of the COVID-19 crisis.

Dolutegravir resistance in Malawi’s national HIV treatment program

Dolutegravir HIV drug resistance (HIVDR) data from Africa remain sparse. We reviewed HIVDR results of Malawians on dolutegravir-based antiretroviral therapy (November 2020–September 2021). Of 6462 eligible clients, 33 samples were submitted to South Africa, 27 were sequenced successfully, and 8 (30%) had dolutegravir HIVDR. Malawi urgently requires adequate HIVDR testing capacity.

The Association Between Scope of Practice Regulations and Nurse Practitioner Prescribing of Buprenorphine After the 2016 Opioid Bill

This article examines the relationship between federal regulations, state scope-of-practice regulations on nurse practitioners (NPs), and buprenorphine prescribing patterns using pharmacy claims data from Optum's deidentified Clinformatics Data Mart between January 2015 and September 2018. The county-level proportion of patients filling prescriptions written by NPs was low even after the 2016 Comprehensive Addiction and Recovery Act (CARA), 2.7% in states that did not require physician oversight of NPs, and 1.1% in states that did. While analyses in rural counties showed higher rates of buprenorphine prescriptions written by NPs, rates were still considerably low: 3.7% in states with less restrictive regulations and 1.1% in other states. These results indicate that less restrictive scope-of-practice regulations are associated with greater NP prescribing following CARA. The small magnitude of the changes indicates that federal attempts to expand treatment access through CARA have been limited.

State-level regulations and opioid-related health outcomes

INTRODUCTION

Due to the ongoing opioid use disorder crisis, improved access to opioid treatment programs (OTPs) is needed. However, OTPs operate in a complex regulatory environment which may limit their ability to positively affect health outcomes. The objective of this study was to examine how the number and type of state OTP regulations are associated with opioid-related deaths, hospitalizations, and emergency department visits.

METHODS

Cross-sectional data capturing information about OTP state-level regulations collected by Jackson et al. was combined with other secondary sources. OTP regulations were categorized based on the nature of their focus. Analyses include bivariate and multivariable regressions that controlled for region and other state laws that can affect opioid outcomes.

RESULTS

In bivariate analysis, a greater number of OTP regulations was positively correlated with both deaths and emergency visits. Moreover, a greater number of regulations in the Physical Facilities Management category (e.g., rules related to restrooms, lighting, and signage) was positively correlated with both deaths and hospitalizations. The number of regulations in the Staffing Requirement category was positively associated with emergency visits. In adjusted analysis, the number of regulations in the Physical Facilities Management category was positively associated with opioid-related deaths.

CONCLUSIONS

States with a higher number of regulations had poorer opioid-related outcomes. Additional research is needed to support policy decisions that can improve access to OTPs and reduce avoidable deaths, hospitalizations, and emergency visits.

Strategic use of health information exchange and market share, payer mix, and operating margins

BACKGROUND

Health information exchange (HIE) capabilities are tied to health care organizations' strategic and business goals. As a technology that connects information from different organizations, HIE may be a source of competitive advantage and a path to improvements in performance.

PURPOSE

The aim of the study was to identify the impact of hospitals' use of HIE capabilities on outcomes that may be sensitive to changes in various contracting arrangements and referral patterns arising from improved connectivity.

METHODOLOGY

Using a panel of community hospitals in nine states, we examined the association between the number of different data types the hospital could exchange via HIE and changes in market share, payer mix, and operating margin (2010-2014). Regression models that controlled for the number of different data types shared intraorganizationally and other time-varying factors and included both hospital and time fixed effects were used for adjusted estimates of the relationships between changes in HIE capabilities and outcomes.

RESULTS

Increasing HIE capability was associated with a 13 percentage point increase in a hospital's discharges that were covered by commercial insurers or Medicare (i.e., payer mix). Conversely, increasing intraorganizational information sharing was associated with a 9.6 percentage point decrease in the percentage of discharges covered by commercial insurers or Medicare. Increasing HIE capability or intraorganizational information sharing was not associated with increased market share nor with operating margin.

CONCLUSIONS

Improving information sharing with external organizations may be an approach to support strategic business goals.

PRACTICE IMPLICATIONS

Organizations may be served by identifying ways to leverage HIE instead of focusing on intraorganizational exchange capabilities.

Marijuana liberalization policies and perinatal health

We studied the effect of marijuana liberalization policies on perinatal health with a multiperiod difference-in-differences estimator that exploited variation in effective dates of medical marijuana laws (MML) and recreational marijuana laws (RML). We found that the proportion of maternal hospitalizations with marijuana use disorder increased by 23% (0.3 percentage points) in the first three years after RML implementation, with larger effects in states authorizing commercial sales of marijuana. This growth was accompanied by a 7% (0.4 percentage points) decline in tobacco use disorder hospitalizations, yielding a net zero effect over all substance use disorder hospitalizations. RMLs were not associated with statistically significant changes in newborn health. MMLs had no statistically significant effect on maternal substance use disorder hospitalizations nor on newborn health and fairly small effects could be ruled out. In absolute numbers, our findings implied modest or no adverse effects of marijuana liberalization policies on the array of perinatal outcomes considered.

Long-term opioid therapy tapering: Trends from 2014 to 2018 in a Midwestern State

BACKGROUND

The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain (Guideline hereafter) emphasized tapering patients from long-term opioid therapy (LTOT) when the harms outweigh the benefits.

METHODS

To examine tapering from LTOT before and after the Guideline release, we conducted a retrospective cohort study of adults with high-dose LTOT (mean of >50 Morphine Milligram Equivalents [MME]/day) from 2014 to 2018 from one Midwest state's Health Information Exchange. We identified tapering (dose reductions in mean MME/day greater than 15%, 30%, 50%) and rapid discontinuation episodes (reduction to zero MME/day) over a 6-month follow-up period relative to a 3-month baseline period. We used segmented regressions to estimate outcomes adjusted for time trends and relevant state laws limiting opioid prescribing.

RESULTS

The Guideline release was associated with statistically significant immediate increase in the patient likelihood of experiencing tapering (15%: 1.8% point [95% confidence interval (CI): 1.2-2.6; 30%: 1.4% point, 95% CI: 0.7-2.2; 50%: 0.8% point, 95% CI: 0.2-1.4) and rapid discontinuation episodes (0.006% point, 95% CI: 0.001-0.01). After the Guideline release, the patient likelihood of tapering increased over time (15%: 0.4% point/month, 95% CI: 0.3-0.5; 30%: 0.3% point/month, 95% CI:0.2-0.4; 50%: 0.3% point/month, 95% CI: 0.2-0.3; rapid discontinuation: 0.01% point/month, 95% CI: 0.007-0.01). Tapering and rapid discontinuation trends was similar among gender and race categories.

CONCLUSION

The Guideline may be a useful tool in altering opioid prescribing practices, particularly for patients on shorter durations of LTOT.

Users of retail medications for opioid use disorders faced high out-of-pocket prescription spending in 2011-2017

INTRODUCTION

High out-of-pocket spending has been a barrier to treatment for the estimated 2.0 million Americans suffering from opioid use disorders (OUD). This paper provides national estimates of financial costs faced by the population receiving retail medications for OUD (MOUD).

METHODS

We used pooled annual data from the 2011-2017 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of the civilian noninstitutionalized population in the United States. The sample includes individuals who reported filling a retail prescription for buprenorphine or naltrexone, the two most common medications available from retail pharmacies to treat OUD. The main outcome is out-of-pocket spending of retail MOUD prescriptions per fill and per person.

RESULTS

Patients with retail MOUD prescriptions spent 3.4 times more out-of-pocket for prescriptions on average than the rest of the U.S. population, with 18.8% of this population paying entirely out-of-pocket for their MOUD prescriptions. Insurance coverage is associated with reduced annual out-of-pocket MOUD expenditures between $316 and $328 per year.

CONCLUSIONS

Future policies that expand insurance and address out-of-pocket spending on MOUD could increase access to medications among individuals with OUD.

The impact of Medicaid expansion on emergency department wait times

OBJECTIVE

To estimate the impact of Medicaid expansion on emergency department (ED) wait times.

DATA SOURCES

We used 2012-2017 hospital-level secondary data from the CMS Hospital Compare data warehouse.

STUDY DESIGN

We used a state-level difference-in-differences approach to identify the impact of Medicaid expansion on four measures of ED wait times: time before being seen by a provider; time before being sent home after being seen by a provider; boarding time spent in the ED waiting to be discharged to an inpatient room; and the percentage of patients who left without being seen. We compared outcomes in states that expanded Medicaid with those in states that did not expand Medicaid.

DATA COLLECTION/EXTRACTION METHODS

Our sample included all US acute care hospitals with EDs in states that did not ever expand Medicaid or that fully expanded Medicaid in January of 2014.

PRINCIPAL FINDINGS

Medicaid expansion was associated with a 3.1-min increase (SE: 0.994, baseline mean: 30.8 min) in the time spent waiting to see an ED provider, a relative increase of 10%. Patients who were eventually sent home after being seen by a provider experienced a 7.5-min increase (SE: 1.8, baseline mean 142.1 min) in wait time. Boarding time rose by 3.8 min (SE 1.9, baseline mean 111.4 min). The percentage of patients who left without being seen rose by 0.3 percentage points (SE: 0.09, baseline mean 2.0), a relative increase of 15.3%.

CONCLUSIONS

This study provides multistate evidence that Medicaid expansion increased ED wait times for patients, indicating that ED crowding may have worsened post-expansion. Future work should aim to uncover the mechanisms through which insurance expansion increased ED wait times to provide policy direction.

US Trends in COVID-19-Associated Hospitalization and Mortality Rates Before and After Reopening Economies

Importance

After abrupt closures of businesses and public gatherings in the US in late spring 2020 due to the COVID-19 pandemic, by mid-May 2020, most states reopened their economies. Owing in part to a lack of earlier data, there was little evidence on whether state reopening policies influenced important pandemic outcomes-COVID-19-related hospitalizations and mortality-to guide future decision-making in the remainder of this and future pandemics.

Objective

To investigate changes in COVID-19-related hospitalizations and mortality trends after reopening of US state economies.

Design Setting and Participants

Using an interrupted time series approach, this cross-sectional study examined trends in per-capita COVID-19-related hospitalizations and deaths before and after state reopenings between April 16 and July 31, 2020. Daily state-level data from the University of Minnesota COVID-19 Hospitalization Tracking Project on COVID-19-related hospitalizations and deaths across 47 states were used in the analysis.

Exposures

Dates that states reopened their economies.

Main Outcomes and Measures

State-day observations of COVID-19-related hospitalizations and COVID-19-related new deaths per 100 000 people.

Results

The study included 3686 state-day observations of hospitalizations and 3945 state-day observations of deaths. On the day of reopening, the mean number of hospitalizations per 100 000 people was 17.69 (95% CI, 12.54-22.84) and the mean number of daily new deaths per 100 000 people was 0.395 (95% CI, 0.255-0.536). Both outcomes displayed flat trends before reopening, but they started trending upward thereafter. Relative to the hospitalizations trend in the period before state reopenings, the postperiod trend was higher by 1.607 per 100 000 people (95% CI, 0.203-3.011; P = .03). This estimate implied that nationwide reopenings were associated with 5319 additional people hospitalized for COVID-19 each day. The trend in new deaths after reopening was also positive (0.0376 per 100 000 people; 95% CI, 0.0038-0.0715; P = .03), but the change in mortality trend was not significant (0.0443; 95% CI, -0.0048 to 0.0933; P = .08).

Conclusions and Relevance

In this cross-sectional study conducted over a 3.5-month period across 47 US states, data on the association of hospitalizations and mortality with state reopening policies may provide input to state projections of the pandemic as policy makers continue to balance public health protections with sustaining economic activity.

Where did the specialty behavioral health workforce grow between 2011 and 2019? Evidence from census data

IMPORTANCE

Given that mental health and substance use conditions are ongoing major public health problems in the United States, it is important for researchers to understand the behavioral health treatment workforce landscape and to assess whether increases in treatment capacity exist in areas with public health needs.

OBJECTIVES

This study quantified national and county-level changes in specialty behavioral health (SBH) workforce outcomes and assessed associations between these measures and age-adjusted drug mortality rate.

DESIGN

Using a novel longitudinal dataset from the U.S. Census Bureau, this study described SBH workforce outcomes in 3130 U.S. counties between 2011 and 2019. The study stratified workforce outcomes, including the number of establishments, likelihood of having establishments, mean number of workers, and average wage of workers per county, by service settings: outpatient, residential, and hospital. The study fitted outcome data at the county level to ordinary least squares regression models as a function of the country's previous year age-adjusted drug mortality rate and county sociodemographic characteristics.

RESULTS

The number of SBH establishments, their workforce, and their wages have increased steadily between 2011 and 2019, with the largest increases occurring in the following settings: outpatient (number of establishments and employment) and residential (average wage). County-level growth of residential SBH establishments was positively and significantly associated with the county's previous year county age-adjusted drug mortality rate. We did not observe a similar positive association between either employment or wages and the mortality rate.

CONCLUSIONS

The increase in the number of SBH establishments in recent years may indicate that the SBH workforce is responding to increased need for treatment; however, more work needs to be done to close behavioral health workforce gaps in areas with an elevated drug overdose mortality rate.

How Much Do Outside Options Matter? The Effect of Subsidized Health Insurance on Social Security Disability Insurance Benefit Receipt

New government health insurance programs may affect participation in existing safety-net benefits that provide health insurance as a secondary aim. We examine whether the outside options for health insurance made available by the Affordable Care Act affected Social Security Disability Insurance (DI) application decisions. Using the universe of U.S. individual income tax records spanning 2007-2016, we first estimate the effect of Medicaid expansions using a state difference-in-differences identification strategy, but find small and statistically insignificant estimates. However, when we estimate the effect of being eligible for high vs. low Marketplace subsidies based on geography, we find some evidence consistent with subsidies increasing DI claiming among those with prior access to Employer Sponsored Insurance, and decreasing DI claiming otherwise. Overall, we find suggestive evidence that outside options for health insurance do matter, though magnitudes are small and results are statistically precise only for Marketplace coverage.

Can policy affect initiation of addictive substance use? Evidence from opioid prescribing

Drug control policy can have unintended consequences by pushing existing users to alternative, possibly more dangerous substances. Policies that target only new users may therefore be especially promising. Using commercial insurance claims data, we provide the first evidence on a set of new policies intended to reduce opioid initiation in the form of limits on initial prescription length. We also provide the first evidence on the impact of must-access prescription drug monitoring programs (MA-PDMPs), laws that do not target new users, on initial opioid use. Although initial limit policies reduce the average length of initial prescriptions, they do so primarily by raising the frequency of short prescriptions, resulting in increases in opioids dispensed to new users. In contrast, we find that MA-PDMPs reduce opioids dispensed to new users, even though they do not explicitly set out to do so. Neither policy significantly affects extreme use such as doctor shopping among new patients, because such behavior is very rare.

Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions

OBJECTIVE

Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions.

MATERIALS AND METHODS

The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor.

RESULTS

Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant.

CONCLUSION

Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.

Is Healthcare Employment Resilient and “Recession Proof”?

Conventional wisdom often holds that the healthcare sector fares better than other sectors during economic downturns. However, little research has examined the relationship between local economic conditions and healthcare employment. Understanding how the healthcare sector responds to economic conditions is important for policymakers seeking to ensure an adequate supply of healthcare workers, as well as for those directing displaced workers into new jobs. We examine the impact of macroeconomic conditions on both the healthcare labor market and the pipeline of healthcare workers receiving healthcare degrees during 2005–2017 (the pre-COVID era). Our results indicate that the healthcare sector is stable across past business cycles. If anything, when areas experience more severe local economic downturns, healthcare employment increases. Much remains unknown about how the healthcare sector will fare during the current recession. Our study represents an important backdrop as policymakers consider ways to sustain the healthcare sector during current economic and public health turbulence.

Levels of Employment and Community Engagement among Low-Income Adults: Implications for Medicaid Work Requirements

CONTEXT

Twenty states are pursuing community engagement requirements ("work requirements") in Medicaid, though legal challenges are ongoing. While most nondisabled low-income individuals work, it is less clear how many engage in the required number of hours of qualifying community engagement activities and what heterogeneity may exist by race/ethnicity, age, and gender. The authors' objective was to estimate current levels of employment and other community engagement activities among potential Medicaid beneficiaries.

METHODS

The authors analyzed the US Census Bureau's national time-use survey data for the years 2015 through 2018. Their main sample consisted of nondisabled adults between 19 and 64 years with family incomes less than 138% of the federal poverty level (N = 2,551).

FINDINGS

Nationally, low-income adults who might become subject to Medicaid work requirements already spent an average of 30 hours per week on community engagement activities. However, 22% of the low-income population-particularly women, older adults, and those with less education-would not currently satisfy a 20-hour-per-week requirement.

CONCLUSIONS

Although the majority of potential Medicaid beneficiaries already meet community engagement requirements or are exempt, 22% would not currently satisfy a 20-hour-per-week requirement and therefore could be at risk for losing coverage.

ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study

The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion. We believe our study provides the first evidence of the health-related effects of ACA Medicaid expansion using the Health and Retirement Study (HRS). Using geo-coded data from 2010 to 2016, we estimate difference-in-differences models, comparing changes in outcomes before and after the Medicaid expansion in treatment and control states among a sample of over 3,000 unique adults aged 50 to 64 with income below 100% of the federal poverty level. The HRS allows us to examine morbidity outcomes not available in administrative data, providing evidence of the mechanisms underlying emerging evidence of mortality reductions due to expanded insurance coverage among the near-elderly. We find that the Medicaid expansion was associated with a 15 percentage point increase in Medicaid coverage which was largely offset by declines in other types of insurance. We find improvements in several measures of health including a 12% reduction in metabolic syndrome; a 32% reduction in complications from metabolic syndrome; an 18% reduction in the likelihood of gross motor skills difficulties; and a 34% reduction in compromised activities of daily living (ADLs). Our results thus suggest that the Medicaid expansion led to improved physical health for low-income, older adults.

Same Game, Different Names: Cream-Skimming in the Post-ACA Individual Health Insurance Market

One of the Affordable Care Act’s (ACA) signature reforms was creating centralized Health Insurance Marketplaces to offer comprehensive coverage in the form of comprehensive insurance complying with the ACA’s coverage standards. Yet, even after the ACA’s implementation, millions of people were covered through noncompliant plans, primarily in the form of continued enrollment in “grandmothered” and “grandfathered” plans that predated ACA’s full implementation and were allowed under federal and state regulations. Newly proposed and enacted federal legislation may grow the noncompliant segment in future years, and the employment losses of 2020 may grow reliance on individual market coverage further. These factors make it important to understand how the noncompliant segment affects the compliant segment, including the Marketplaces. We show, first, that the noncompliant segment of the individual insurance market substantially outperformed the compliant segment, charging lower premiums but with vastly lower costs, suggesting that insurers have a strong incentive to enter the noncompliant segment. We show, next, that state’s decisions to allow grandmothered plans is associated with stronger financial performance of the noncompliant market, but weaker performance of the compliant segment, as noncompliant plans attract lower-cost enrollees. This finding indicates important linkages between the noncompliant and compliant segments and highlights the role state policy can play in the individual insurance market. Taken together, our results point to substantial cream-skimming, with noncompliant plans enrolling the healthiest enrollees, resulting in higher average claims cost in the compliant segment.

Characterizing variability in state-level regulations governing opioid treatment programs

INTRODUCTION

The opioid use crisis has left nearly 1 million people in need of treatment. States have focused primarily on policies aimed at decreasing the prevalence of opioid use disorder. However, opioid treatment programs (OTPs), an evidence-based modality which can prevent and decrease opioid-related mortality and morbidity, remain highly complex with variation in treatment by state. Evidence-based state-level regulation of OTPs can be a powerful tool and may help improve the unmet need for treatment. This study characterized the variability in state laws that regulate OTPs and examines how this variability is associated with state characteristics. Our data provides an opportunity for policymakers to consider regulations that increase access to care and retention in OTPs, which could improve population health.

MATERIALS AND METHODS

Utilizing policy mapping techniques, we identified all regulations governing OTPs in effect on January 1, 2017 and determined whether the most common regulations were consistent with best practices. We then examined how the number and type of regulations were associated with state characteristics. All policy mapping research was conducted between November 2017 and March 2019.

RESULTS

We identified 89 different regulations, the most common of which exists in fewer than half of all states; and most exist in <25% of states. Eighteen of the 30 most common regulations were inconsistent with best practice recommendations. Overall, variability in the number and type of OTP regulations was related to geographic location as opposed to state size.

CONCLUSIONS

Wide-ranging variability exists in the regulations of OTPs across the U.S. Most state OTP regulations are not congruent with best practices.

Serum betatrophin and irisin levels in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) development is a complex process with well-known risk factors, however the role of betatrophin/angiopoietin-like protein 8 and irisin has been poorly investigated thus far. The aim of this study is to measure betatrophin and irisin serum levels in HCC, cirrhotic patients and controls, assess their relationship with cancer etiology and grade, metabolic abnormalities and liver dysfunction severity. Serum betatrophin and irisin concentrations were measured with commercially available ELISA kits in 69 cirrhotic patients with HCC, 24 patients with non-viral cirrhosis and 20 healthy volunteers. The severity of liver disfunction was assessed according to Child-Pugh (C-P) score, while HCC grade according to the Barcelona clinic liver cancer (BCLC) staging system. Serum betatrophin concentration was significantly higher (33.7 ± 13.4 versus 12.3 ± 2.0 ng/ml; P < 0.001), while serum irisin level significantly lower in HCC patients compared to controls (2.52 ± 1.14 versus 4.46 ± 1.34 μg/ml; P = 0.02). Betatrophin level was also significantly elevated among cirrhotic patients compared to healthy volunteers. More evident serum betatrophin increase was found in patients with viral disease (34.8 ± 12.9 versus 26.1 ± 13.8 ng/ml; P < 0.001). Serum irisin concentration was significantly decreased in more advanced HCC cases (stage A versus C according to BCLC: 3.4 ± 1.3 versus 1.89 ± 1.1 μg/ml; P = 0.02). Decline of serum irisin (A: 3.4 ± 1.2; B: 2.42 ± 0.8; C: 1.91 ± 1.19 μg/ml; P = 0.03) and up-regulation of serum betatrophin levels (A: 24.1 ± 13.8; B: 39.3 ± 11.4; C: 46.2 ± 9.4 ng/ml; P = 0.03) were observed in patients with more advanced cirrhosis according to C-P score. We concluded that betatrophin serum level increased in cirrhotic patients, compared to controls. Since there was no difference between cirrhotic patients with and without intercurrent HCC, we suppose it may have an influence on fibrosis development, however not hepatocarcinogensis. Irisin serum level decreased in HCC patients, especially with more advanced disease grade, and was inversely related to the severity of liver disfunction.