AASLD: 2016: Article: HCV is an independent predictor of hospital readmission in inmates – Alan Franciscus
Author/Source: Alysse Wurcel/ Abstract # 774
There is a high percentage of people with chronic hepatitis C incarcerated in American prisons. Lemuel Shattuck Hospital (LSH) provides medical services to the inmates in Massachusetts. In the current study, the authors developed a database of inmates discharged from LSH from 2004 to 2014 that collect length of stay, all ICD-9 codes (The International Classification of Diseases – 9th Revision), and patient characteristics.
The records of 911 HCV-positive inmate records were compared to HCV-negative patients. The age, gender (male), and race were similar.
The people who were HCV positive were more likely to stay 2 days longer (on average), were HIV positive (15.8% vs. 2.8%); had a hospital readmission to (even once) (36.0% vs. 26.4%); readmission (<30 days) (14.8% vs. 9.7%).
Hepatitis C is associated with 20% inmate admissions, 20% increase in the length of stay and a 30% increase in the odds of readmission to Lemuel Shattuck Hospital in Massachusetts. Not surprisingly, ICD-9: liver disease is the 3rd most common reason for admission—11% of inmates with HCV are admitted with liver disease as the primary /secondary vs. 1.6% of inmates without HCV.
The findings are not surprising since there is a high prevalence of hepatitis C in prisons. At some point, we must start to tackle treatment of hepatitis C in prisons. Many people don’t realize that when people get out of prison, they integrate into our communities. Treating prisoners is not only humane, but it benefits every community and stops the spread of hepatitis C.
Background: Understanding the burden of HCV-related hospitalizations in inmates is important to making rational policy about HCV treatment in prisons. We compared hospital lengths of stay and readmission by HCV infection status among inmates. Methods: Lemuel Shattuck Hospital (LSH) provides inpatient medical services to inmates in MA. We used billing records to develop a database of inmate discharges from LSH 2004 to 2014. Data collected included: age, race, gender, date of admission & discharge, length of stay (LOS), all reported ICD-9 codes, and disposition from hospital (died, back to prison, to another hospital). We identified HCV-infected individuals by using HCV-associated ICD-9 codes (070.41, 070.44, 070.51, 070.54, 070.70, 070.71). We compared HCV-infected to un-infected individuals. The primary outcomes were LOS and odds of readmission to LSH. Logistic regression adjusted for confounding by age, sex, race, LOS of first admission, and co-morbidities (Elixhauser index). Results: 4668 inmates contributed a total of 8397 discharges. 93% of inmates were male, 53% were white, median age at first hospitalization was 44 yrs (IQR 34, 52). HCV ICD-9 codes were associated with of 20% of hospitalizations. Median LOS was 5 days (IQR 2, 9). Inmates with HCV were older (46 vs. 42, p<0.001) and had longer mean LOS (6 days vs. 5 days, p<0.001). In multivariable modeling, HCV remained associated with increased odds of readmission (1.3, CI (1.1-1.6)). Conclusion: In MA, HCV-infection is associated with 20% of inmate admissions, a 20% increase in LOS, and a 30% increase in the odds of readmission to the hospital. Treatment may not avert all of the observed increase in hospitalization, but HCV is associated with many admissions and modest reductions in hospital utilization after SVR could help offset treatment costs.