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Díaz Carnicero J, Saurí-Ferrer I, Redon J, Navarro J, Fernández G, Hurtado C, Ferreira K, Alvarez-Ortega C, Gómez A, Martos-Rodríguez CJ, Martí-Aguado D, Escudero D, Cedenilla M. Clinical and Economic Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in a Spanish Mediterranean Region: A Population-Based Study. J Clin Med 2025; 14:2441. [PMID: 40217891 PMCID: PMC11989979 DOI: 10.3390/jcm14072441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 03/28/2025] [Accepted: 03/30/2025] [Indexed: 04/14/2025] Open
Abstract
Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent condition worldwide, with significant regional variability in prevalence estimates. This study aimed to determine the prevalence, demographic characteristics, and economic burden of MASLD, metabolic dysfunction-associated steatotic liver (MASL), and metabolic dysfunction-associated steatohepatitis (MASH) in the Valencian Community region of Spain. Methods: We conducted a retrospective analysis of electronic medical records from the Valencian public healthcare database of individuals aged over 24 years from 2012 to 2019. Results: Of the 3,411,069 individuals included in the database in 2019, 75,565 were diagnosed with MASLD, 74,065 with MASL, and 1504 with MASH based on the International Classification of Diseases (ICD), corresponding to a prevalence of 2.22%, 2.17%, and 0.04%, respectively. Among individuals with type 2 diabetes mellitus (T2DM) or obesity, the prevalence of MASLD was approximately three times and 2.5 times higher, respectively, compared to the overall population. The prevalence of MASLD, MASL, and MASH increased from 2012 to 2019 in all the populations studied. The highest risk of hospitalization was associated with liver-related causes, followed by all-cause hospitalization. The highest cost per subject in 2019 was observed in individuals with concomitant MASH and T2DM. Conclusions: Our findings indicate a rising prevalence of MASLD, MASL, and MASH, despite their potential underdiagnosis during the study period. The presence of MASLD or MASH was associated with high healthcare costs, particularly in patients with MASH and T2DM. Our results underline the need for more effective strategies to enhance disease awareness and improve resource allocation.
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Affiliation(s)
- Javier Díaz Carnicero
- Instituto de Investigación Sanitaria Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Hospital Clínico Universitario, 46010 Valencia, Spain; (J.D.C.); (I.S.-F.); (J.R.); (J.N.); (D.M.-A.)
| | - Inma Saurí-Ferrer
- Instituto de Investigación Sanitaria Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Hospital Clínico Universitario, 46010 Valencia, Spain; (J.D.C.); (I.S.-F.); (J.R.); (J.N.); (D.M.-A.)
| | - Josep Redon
- Instituto de Investigación Sanitaria Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Hospital Clínico Universitario, 46010 Valencia, Spain; (J.D.C.); (I.S.-F.); (J.R.); (J.N.); (D.M.-A.)
| | - Jorge Navarro
- Instituto de Investigación Sanitaria Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Hospital Clínico Universitario, 46010 Valencia, Spain; (J.D.C.); (I.S.-F.); (J.R.); (J.N.); (D.M.-A.)
| | - Gonzalo Fernández
- Value & Implementation, Global Medical & Scientific Affairs, MSD Spain, 28027 Madrid, Spain
| | - Carlos Hurtado
- Value & Implementation, Global Medical & Scientific Affairs, MSD Spain, 28027 Madrid, Spain
| | - Karine Ferreira
- Value & Implementation, Global Medical & Scientific Affairs, MSD Spain, 28027 Madrid, Spain
| | | | - Antón Gómez
- Value & Implementation, Global Medical & Scientific Affairs, MSD Spain, 28027 Madrid, Spain
| | | | - David Martí-Aguado
- Instituto de Investigación Sanitaria Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Hospital Clínico Universitario, 46010 Valencia, Spain; (J.D.C.); (I.S.-F.); (J.R.); (J.N.); (D.M.-A.)
- Gastroenterology and Hepatology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Desamparados Escudero
- Gastroenterology and Hepatology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
| | - Marta Cedenilla
- Value & Implementation, Global Medical & Scientific Affairs, MSD Spain, 28027 Madrid, Spain
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Lyu X, Liu B, Li Y, Wang Y, Miskovsky J, Gaitanis M, Promrat K, Wu WC. Impact of Non-Alcoholic Fatty Liver Disease on Sepsis Inpatient Outcomes: A Nationwide Sample Analysis (2000-2019). J Clin Med 2024; 13:5737. [PMID: 39407795 PMCID: PMC11476451 DOI: 10.3390/jcm13195737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 09/13/2024] [Accepted: 09/24/2024] [Indexed: 10/20/2024] Open
Abstract
Background/Objectives: Patients with Non-Alcoholic Fatty Liver Disease (NAFLD) are reported to have an increased risk of developing severe infections, leading to hospitalizations with sepsis. However, data regarding the impact of comorbid NAFLD on in-hospital outcomes of patients with sepsis is scarce. Methods: This nationwide retrospective observational study using discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality included 21,057,911 adult patients who were admitted to hospitals in the United States between 2000 and 2019 with a primary discharge diagnosis of sepsis. These patients were categorized according to the presence or absence of comorbid NAFLD. The twenty-year trend of nationwide NAFLD prevalence among sepsis inpatients was elucidated. Multivariable logistic regression analysis was used to analyze NAFLD's impact on sepsis outcomes. Results: In the twenty-year study period, the prevalence of NALFD among sepsis inpatients trended up from 1.2% in 2000 to 4.2% in 2019. Similar trends were observed in regional analysis. While overall sepsis mortality decreased, comorbid NAFLD in sepsis patients was consistently associated with a higher adjusted in-hospital all-cause mortality rate (adjusted odds ratio (OR), 1.19; 95% confidence interval (CI), 1.07-1.32), higher odds of developing septic shock, and higher likelihood of development of multi-organ dysfunction. Conclusions: Comorbid NAFLD in the stage of NASH or cirrhosis is associated with higher in-hospital all-cause mortality and worse clinical outcomes in sepsis inpatients. Addressing this rising epidemic will be of paramount importance to improve sepsis in-hospital outcomes.
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Affiliation(s)
- Xiuhong Lyu
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, USA;
- Department of Adult Medicine, Brockton Neighborhood Health Center, 63 Main Street, Brockton, MA 02301, USA
| | - Bolun Liu
- Department of Hospital Internal Medicine, Mayo Clinic Health System, 1025 Marsh Street, Mankato, MN 56001, USA;
| | - Yiting Li
- Division of Gastroenterology and Hepatology, University of New–Mexico Health Science Center, 2500 Marble Ave., Albuquerque, NM 87106, USA
| | - Yichen Wang
- Division of Hospital Medicine, The Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA;
| | - John Miskovsky
- Department of Internal Medicine, Roger Williams Medical Center, 825 Chalkstone Ave., Providence, RI 02908, USA;
| | - Melissa Gaitanis
- Department of Infectious Disease, Providence VA Medical Center, 830 Chalkstone Ave., Providence, RI 02903, USA;
| | - Kittichai Promrat
- Providence VA Medical Center, Section of Gastroenterology, 830 Chalkstone Ave., Providence, RI 02908, USA;
| | - Wen-Chih Wu
- Department of Medicine, Division of Cardiology, Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
- Center of Innovation for Long Term Services & Support, Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI 02908, USA
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Heredia NI, John JC, Singh S, Hwang JP, Strong LL, Balakrishnan M, McNeill LH. Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241241272. [PMID: 38529894 PMCID: PMC10967000 DOI: 10.1177/00469580241241272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/27/2024]
Abstract
Primary care physicians (PCPs) are well suited to manage patients with non-alcoholic fatty liver disease (NAFLD), but the limited, existing research suggests inadequate knowledge about the natural history, diagnostic methods, and management of NAFLD. The purpose of this qualitative study is to further understand the knowledge and practices for the diagnosis and management of NAFLD among PCPs. We conducted in-depth interviews with PCPs in the Greater Houston area, addressing current clinical practices used for diagnosing and managing NAFLD, as well as the perceptions of the PCPs regarding the burden of NAFLD on patients. We recorded interviews, transcribed them, coded transcripts, and identified patterns and themes. The interviewed PCPs (n = 16) were from internal or family medicine, with a range of experience (1.5-30 years). We found variations in NAFLD diagnosis and management across practices and by insurance status. Patients with abnormal liver imaging who had insurance or were within a safety-net healthcare system were referred by PCPs to specialists. Uninsured patients with persistently elevated liver enzymes received lifestyle recommendations from PCPs without confirmatory imaging or specialist referral. The role of PCPs in NAFLD management varied, with some helping patients set dietary and physical activity goals while others provided only general recommendations and/or referred patients to a dietitian. The diagnosis and management of NAFLD vary widely among PCPs and may be impacted by patients' insurance status and clinic-specific practices. The increasing burden of NAFLD in the U.S. medical system highlights the need for more PCPs involvement in managing NAFLD.
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Affiliation(s)
- Natalia I. Heredia
- Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA
- Center for Health Equity, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA
| | - Jemima C. John
- Center for Health Equity, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA
- Department of Epidemiology, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA
| | - Sonia Singh
- The University of Texas Health Science Center at Houston, Houston TX, USA
| | - Jessica P. Hwang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larkin L. Strong
- Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maya Balakrishnan
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Lorna H. McNeill
- Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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