Burden of Cirrhosis on Older Americans and Their Families: Analysis of the Health and Retirement Study
Open accessAbstract
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. (Hepatology 2012;55:184–191)
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Patients were identified by a validated EMR case identification algorithm based on ICD-9 or ICD-10 codes for cirrhosis or cirrhosis complications.
“Patients were identified by a validated EMR case identification algorithm based on International Classification of Diseases–Ninth Revision (ICD-9) or International Classification of Diseases–Tenth Revision (ICD-10) codes for cirrhosis (571.2 or 571.5; K70.30 or K74.6) or cirrhosis complications”
From Depression and anxiety are common among patients with cirrhosis (2022) · cites this paper as [18]
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Burden of Cirrhosis on Patients and Caregivers
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Predicting 30-Day Hospital Readmission Risk in a National Cohort of Patients with Cirrhosis
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ACG Clinical Guideline: Hepatic Encephalopathy
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Contemporary management of pain in cirrhosis: Toward precision therapy for pain
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Same- vs Different-Hospital Readmissions in Patients With Cirrhosis After Hospital Discharge
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Elevated liver enzymes in individuals with undiagnosed diabetes in the U.S.
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Deprescribing zolpidem reduces falls and fractures in patients with cirrhosis
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Approaches to Assessing Burden in Caregivers of Patients with Cirrhosis
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Hepatic Encephalopathy is a Strong Predictor of Early Hospital Readmission Among Cirrhosis Patients
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- Authors
- Rakoski, M. O., McCammon, R. J., Piette, J. D., Iwashyna, T. J., Marrero, J. A., Lok, A. S., Langa, K. M., & Volk, M. L.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Rakoski, Mina O.
- ORCID
- Venue
- Hepatology
- Published
- 2012-01
- Volume
- 55
- Issue
- 1
- Pages
- 184-191
- ISSN
- 0270-9139 (ISSN-L)
- PMC
- PMC3462487
- OpenAlex
- W2133184964
- Cited by
- 190
- References
- 38
- Citations by year
- 2026: 13 · 2025: 10 · 2024: 9 · 2023: 14 · 2022: 18 · 2021: 14 · 2020: 19 · 2019: 20 · 2018: 17 · 2017: 14 · 2016: 9 · 2015: 11 · 2014: 10 · 2013: 7 · 2012: 5
- FWCI
- 4.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs (U01 AG09740)
- National Institutes of Health
- National Institute on Aging (AG09740, U01 AG 09740, R01AG030155, U01AG009740)
- National Heart, Lung, and Blood Institute (K08HL091249)
- National Institute of Diabetes and Digestive and Kidney Diseases (T32 DK62708, K24DK084208, K23DK085204, T32DK062708)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Keywords
- liver cirrhosis, older adults, functional disability, activities of daily living, instrumental activities of daily living, informal care, caregiver burden, health care utilization, comorbidities, self-rated health, hospitalization, frailty, Health and Retirement Study, Medicare
- MeSH terms
- Aged, Black or African American, Disability Evaluation, Female, Medicare, Health Status, Hispanic or Latino, Humans, Liver Cirrhosis, Male, Medicaid, Prospective Studies, Retirement, United States, Comorbidity, Incidence, Prevalence, Databases, Factual, Caregivers, Health Care Costs, Cost of Illness, Black People, White People
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