{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T09:30:45Z","timestamp":1740130245567,"version":"3.37.3"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,8,19]],"date-time":"2020-08-19T00:00:00Z","timestamp":1597795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Alcoholic hepatitis (AH) and alcoholic cirrhosis disproportionately affect ethnic minority and safety-net populations. We evaluate the impact of a hospital\u2019s safety net burden (SNB) on in-hospital mortality and costs among patients with AH and alcoholic cirrhosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a cross-sectional analysis of 2012\u20132016 National Inpatient Sample. SNB was calculated as percentage of hospitalizations with Medicaid or uninsured payer status. Associations between hospital SNB and in-hospital mortality and costs were evaluated with adjusted multivariable logistic regression and linear regression models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 21,898 AH-related hospitalizations, compared to low SNB hospitals (LBH), patients hospitalized in high SNB hospitals (HBH) were younger (44.4 y vs. 47.4 y, P\u00a0&amp;lt;\u00a00.001) and more likely to be African American (11.3% vs. 7.7%, P\u00a0&amp;lt;\u00a00.001) or Hispanic (15.4% vs. 8.4%, P\u00a0&amp;lt;\u00a00.001). AH-related hospitalizations in HBH had a non-significant trend towards higher odds of mortality (OR 1.27, 95% CI 0.98\u20131.65, P\u00a0=\u00a00.07) and higher mean hospitalizations costs. Among 108,669 alcoholic cirrhosis-related hospitalizations, patients in HBH were younger (53.3 y vs. 55.8 y, P\u00a0&amp;lt;\u00a00.001) and more likely to be African American (8.2% vs. 7.3%, P\u00a0&amp;lt;\u00a00.001) or Hispanic (24.4% vs. 12.0%, P\u00a0&amp;lt;\u00a00.001) compared to LBH. Compared to alcoholic cirrhosis-related hospitalizations in LBH, mortality was higher among medium SNB (OR 1.10, 95% CI 1.03\u20131.17, P\u00a0=\u00a00.007) and HBH (OR 1.07, 95% CI 1.00\u20131.15, P\u00a0=\u00a00.05). Mean hospitalization costs were not different by SNB status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>HBH hospitals predominantly serve ethnic minorities and underinsured\/uninsured populations. The higher in-hospital mortality associated HBH particularly for alcoholic cirrhosis patients is alarming given its increasing burden in the USA.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/alcalc\/agaa081","type":"journal-article","created":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T19:23:07Z","timestamp":1595359387000},"page":"368-375","source":"Crossref","is-referenced-by-count":10,"title":["Impact of Safety-Net Burden on In-Hospital Mortality and Hospitalization Costs Among Patients with Alcoholic Hepatitis and Alcoholic Cirrhosis"],"prefix":"10.1093","volume":"56","author":[{"given":"Sanah","family":"Ladhani","sequence":"first","affiliation":[{"name":"Department of Medicine, Alameda Health System, Highland Hospital, Oakland, CA 94602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grishma","family":"Hirode","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, M5G 2C4, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashwani K","family":"Singal","sequence":"additional","affiliation":[{"name":"University of South Dakota Sanford School of Medicine and Avera Transplant Institute, Sioux Falls, SD 57105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8923-2806","authenticated-orcid":false,"given":"Robert J","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA"},{"name":"Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,8,19]]},"reference":[{"key":"2021062213001290800_ref1","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.1001\/jama.284.16.2061","article-title":"Unmet health needs of uninsured adults in the United States","volume":"284","author":"Ayanian","year":"2000","journal-title":"JAMA"},{"key":"2021062213001290800_ref2","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1053\/j.gastro.2015.07.056","article-title":"Trends in burden of cirrhosis and hepatocellular carcinoma by underlying liver disease in US veterans, 2001-2013","volume":"149","author":"Beste","year":"2015","journal-title":"Gastroenterology"},{"year":"2019","author":"Bureau of Labor Statistics","key":"2021062213001290800_ref3"},{"key":"2021062213001290800_ref4","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1001\/archinternmed.2012.3158","article-title":"Patient experience in safety-net hospitals: implications for improving care and value-based purchasing","volume":"172","author":"Chatterjee","year":"2012","journal-title":"Arch Intern Med"},{"key":"2021062213001290800_ref5","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1001\/jamaoto.2013.611","article-title":"The effect of hospital safety-net burden status on short-term outcomes and cost of care after head and neck cancer surgery","volume":"138","author":"Genther","year":"2012","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"2021062213001290800_ref6","doi-asserted-by":"crossref","first-page":"562","DOI":"10.14309\/ajg.0000000000000484","article-title":"Disease severity is associated with higher healthcare utilization in nonalcoholic steatohepatitis medicare patients","volume":"115","author":"Gordon","year":"2019","journal-title":"Am J Gastroenterol"},{"key":"2021062213001290800_ref7","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1001\/jamapsychiatry.2017.2161","article-title":"Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: results from the National Epidemiologic Survey on alcohol and related conditions","volume":"74","author":"Grant","year":"2017","journal-title":"JAMA Psychiat"},{"volume-title":"Healthcare Cost and Utilization Project (HCUP)","year":"2019","author":"HCUP Databases","key":"2021062213001290800_ref8"},{"volume-title":"Healthcare Cost and Utilization Project (HCUP) [Internet]","year":"2015","author":"HCUP NIS Trend Weights","key":"2021062213001290800_ref9"},{"volume-title":"Nationwide Inpatient Sample Redesign Final Report. 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