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Pediatric Non-Alcoholic Fatty Liver Disease (NAFLD): Trends, Mortality, and Socioeconomic Disparities in the U.S.,
Paul Wasuwanich1,2, Joshua M So2, Mustafa Sadek1
1Department of Internal Medicine, Naples Comprehensive Health, Naples, FL 34102, USA.
Insights
Hospitalizations for pediatric nonalcoholic fatty liver disease (NAFLD) are rising rapidly. Key mortality risk factors include coagulopathy, while older age, diabetes, and obesity may be protective in hospitalized children.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Epidemiology
Background:
- Non-alcoholic fatty liver disease (NAFLD) is a growing concern in pediatric populations.
- Understanding the inpatient epidemiology and mortality risk factors for pediatric NAFLD is crucial.
Purpose of the Study:
- To describe the evolving inpatient epidemiology of NAFLD in U.S. pediatric patients.
- To identify significant risk factors associated with mortality in hospitalized children with NAFLD.
Main Methods:
- Utilized National Inpatient Sample data from 1998-2020.
- Identified pediatric patients (<18 years) with NAFLD using ICD-9/ICD-10 codes.
- Analyzed mortality risk factors via logistic regression.
Main Results:
- Identified 68,869 pediatric NAFLD hospitalizations; 1.4% resulted in mortality.
- Hospitalization rates significantly increased from 1998-2020 (IRR: 1.07).
- Mortality varied by hospital type. Coagulopathy increased mortality risk; age ≥12, diabetes, and obesity were associated with decreased mortality.
Conclusions:
- Pediatric NAFLD hospitalizations are increasing, highlighting a growing public health issue.
- Identified key risk factors for mortality in hospitalized pediatric NAFLD patients.
- Further research is warranted as more data become available for this population.
Background/Objectives:
We aim to describe the changing inpatient epidemiology of NAFLD in the U.S. and identify major risk factors associated with mortality in the disease among hospitalized pediatric patients.
Methods:
Hospitalization data from the 1998-2020 National Inpatient Sample were utilized. ICD-9 and ICD-10 codes were used to identify pediatric patients (age less than 18 years old) with NAFLD, and risk factors for mortality were analyzed by logistic regression.
Results:
We identified 68,869 pediatric hospitalizations involving NAFLD. Among those, 970 (1.4%) died during hospitalization. Hospitalization rates have been rapidly increasing from 1998 to 2020 (incidence rate ratio (IRR): 1.07; 95% CI: 1.06-1.07; p < 0.001). There was a significant difference in mortality based on the type of hospital (rural, non-teaching urban, or teaching urban) in pediatric patients with NAFLD (p < 0.05). Coagulopathy was significantly associated with increased odds of mortality, while age ≥ 12 years, diabetes and obesity were associated with decreased odds of mortality (p < 0.05). Sex, race/ethnicity, hepatitis B, hepatitis C, HIV, and IV drug use were not significantly associated with mortality.
Conclusions:
Our study has shown ever increasing hospitalization rates for NAFLD in pediatric populations and well as significant risk factors associated with mortality. Further studies should be performed as more data on this patient population are collected.
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