Impact of the COVID-19 pandemic on hospitalizations with hepatocellular carcinoma in the United States

ABSTRACT

Background

We studied the temporal trends of hepatocellular carcinoma (HCC)-related hospitalizations and potential predictors of in-hospital mortality around the COVID-19 pandemic.

Research design and methods

Using the International Classification of Diseases code, we used the National Inpatient Sample 2019–2020 and defined HCC and its underlying etiology. To assess the impact of the COVID-19 pandemic on hospitalization and in-hospital mortality, the study period was divided into the pre-COVID-19 era (2019 Q1–2020 Q1) and the COVID-19 era (2020 Q2–2020 Q4). Quarterly trends in etiology-based hospitalizations with HCC and predictors of in-hospital mortality among hospitalizations with HCC were determined.

Results

Hospitalization rates for HCC, as well as viral hepatitis-related HCC hospitalization rates, remained stable, while hospitalizations with alcohol-related liver disease (ALD, quarterly percentage change [QPC]: 2.1%; 95% confidence interval [CI]: 0.1%-4.2%) increased steadily. Hospitalization related to nonalcoholic fatty liver disease (NAFLD)-related HCC increased significantly steeper in the COVID-19 era (QPC: 6.6%; 95% CI: 4.0%-9.3%) than in the pre-COVID-19 era (QPC: 0.7%; 95% CI: 0.2%-1.3%). COVID-19 infection was independently associated with in-hospital mortality among hospitalizations with HCC (odds ratio: 1.94, 95% CI: 1.30–2.88).

Conclusion

Hospitalization rates for viral hepatitis-related HCC remained stable, while those for HCC due to ALD and NAFLD increased during the COVID-19 pandemic.

KEYWORDS:

• Coronavirus
• liver cancer
• mortality
• NIS
• hospitalization

Abbreviations

ALD	=	alcohol-related liver disease
APC	=	annual percent change
CI	=	confidence interval
COVID-19	=	coronavirus disease 2019
HBV	=	hepatitis B infection
HCC	=	hepatocellular carcinoma
HCV	=	hepatitis C infection
ICD-10-CM	=	International Classification of Diseases, 10th Revision, Clinical Modification
NAFLD	=	nonalcoholic fatty liver disease
NIS	=	National Inpatient Sample
OR	=	odds ratio
Q	=	quarter
QPC	=	quarterly percent change

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

P Konyn and B J. Perumpail were involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and approval of the final draft manuscript.

K Wijarnpreecha and G Cholankeril were involved in interpretation of data, critical revision of the manuscript for important intellectual content, and approval of the final draft manuscript.

A Ahmed and D Kim were involved in study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, study supervision, and approval of the final draft manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

The National Inpatient Sample data set are available at Healthcare Cost and Utilization Project (HCUP) (https://www.hcup-us.ahrq.gov).

Ethics approval statement

As the National Inpatient Sample data sets are completely de-identified and publicly available, this analysis per se was deemed exempt by the Institutional Review Board.

Informed consent

The National Inpatient Sample data sets are based on an all-payer de-identified inpatient healthcare database, which did not require patient consent.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474124.2024.2319580

Additional information

Funding

This paper was not funded.