Burden of cirrhosis on older Americans and their families: analysis of the health and retirement study.

TitleBurden of cirrhosis on older Americans and their families: analysis of the health and retirement study.
Publication TypeJournal Article
Year of Publication2012
AuthorsRakoski, MO, McCammon, RJ, Piette, JD, Iwashyna, TJ, Marrero, JA, Lok, AS, Langa, KM, Volk, ML
JournalHepatology
Volume55
Issue1
Pagination184-91
Date Published2012 Jan
ISSN Number1527-3350
KeywordsAfrican Continental Ancestry Group, Aged, Caregivers, Comorbidity, Cost of Illness, Databases, Factual, Disability Evaluation, European Continental Ancestry Group, Female, Health Care Costs, Health Status, Hispanic Americans, Humans, Incidence, Liver Cirrhosis, Male, Medicaid, Medicare, Prevalence, Prospective Studies, Retirement, United States
Abstract

UNLABELLED: Prevalence of cirrhosis among older adults is expected to increase; therefore, we studied the health status, functional disability, and need for supportive care in a large national sample of individuals with cirrhosis. A prospective cohort of individuals with cirrhosis was identified within the longitudinal, nationally representative Health and Retirement Study. Cirrhosis cases were identified in linked Medicare data via ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes and compared to an age-matched cohort without cirrhosis. Two primary outcome domains were assessed: (1) patients' health status (perceived health status, comorbidities, health care utilization, and functional disability as determined by activities of daily living and instrumental activities of daily living), and (2) informal caregiving (hours of caregiving provided by a primary informal caregiver and associated cost). Adjusted negative binomial regression was used to assess the association between cirrhosis and functional disability. A total of 317 individuals with cirrhosis and 951 age-matched comparators were identified. Relative to the comparison group, individuals with cirrhosis had worse self-reported health status, more comorbidities, and used significantly more health care services (hospitalizations, nursing home stays, physician visits; P < 0.001 for all bivariable comparisons). They also had greater functional disability (P < 0.001 for activities of daily living and instrumental activities of daily living), despite adjustment for covariates such as comorbidities and health care utilization. Individuals with cirrhosis received more than twice the number of informal caregiving hours per week (P < 0.001), at an annual cost of US $4700 per person.

CONCLUSION: Older Americans with cirrhosis have high rates of disability, health care utilization, and need for informal caregiving. Improved care coordination and caregiver support is necessary to optimize management of this frail population.

Notes

Rakoski, Mina O McCammon, Ryan J Piette, John D Iwashyna, Theodore J Marrero, Jorge A Lok, Anna S Langa, Kenneth M Volk, Michael L K23 DK085204-01/DK/NIDDK NIH HHS/United States R01 AG030155-01/AG/NIA NIH HHS/United States T32 DK062708-05/DK/NIDDK NIH HHS/United States United States Hepatology (Baltimore, Md.) Hepatology. 2012 Jan;55(1):184-91. doi: 10.1002/hep.24616.

DOI10.1002/hep.24616
User Guide Notes

http://www.ncbi.nlm.nih.gov/pubmed/21858847?dopt=Abstract

Endnote Keywords

alcohol Abuse/cirrhosis/cirrhosis/Self assessed health/COMORBIDITY/health care/HOSPITALIZATION/physician visits/physician visits

Endnote ID

62711

Alternate JournalHepatology
Citation Key7683
PubMed ID21858847
PubMed Central IDPMC3462487
Grant ListT32 DK062708 / DK / NIDDK NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
R01 AG030155 / AG / NIA NIH HHS / United States
K08HL091249 / HL / NHLBI NIH HHS / United States
T32 DK62708 / DK / NIDDK NIH HHS / United States
K23 DK085204 / DK / NIDDK NIH HHS / United States
T32 DK062708-05 / DK / NIDDK NIH HHS / United States
U01 AG09740 / AG / NIA NIH HHS / United States
K24 DK084208 / DK / NIDDK NIH HHS / United States
R01 AG030155-01 / AG / NIA NIH HHS / United States
K23 DK085204-01 / DK / NIDDK NIH HHS / United States
K08 HL091249 / HL / NHLBI NIH HHS / United States
K23DK085204 / DK / NIDDK NIH HHS / United States