Gastroenterology

Gastroenterology

Volume 136, Issue 4, April 2009, Pages 1134-1144
Gastroenterology

Mini-Reviews and Perspectives
Burden of Digestive Diseases in the United States Part III: Liver, Biliary Tract, and Pancreas

https://doi.org/10.1053/j.gastro.2009.02.038Get rights and content

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Viral Hepatitis

Together, viral hepatitis A, B, and C were listed on 3.5 million ambulatory care visits and 475,000 hospital discharges in 2004. Rates of both ambulatory care visits and hospitalizations increased >4-fold during the preceding 10 years, driven by recognition of, and the surge in medical care for, hepatitis C. Of the 12,656 death certificates that listed viral hepatitis, 42.6% listed it as the underlying cause, resulting in 101,800 years of potential life lost (YPLL) before age 75 years, which

Hepatitis A

Although this infection is common, hepatitis A is infrequently recognized in medical care statistics. Between 1979 and 1993, hospitalization rates with a diagnosis of hepatitis A declined by about 75% from 6.5 to 1.7 per 100,000 population, and remained relatively stable through 2004. In that year, hepatitis A was listed on approximately 10,000 hospital discharges. Mortality from hepatitis A was rare, with <100 deaths per year. Unlike recently stable rates of hospitalizations, the death rate

Hepatitis B

Infections with hepatitis B were most commonly recognized on outpatient visits between ages 15 and 44 years, and hospitalizations with the diagnosis occurred across the age range of adults. Age-adjusted rates of ambulatory care visits were about 5 times higher among whites than blacks and among males than females. Age-adjusted hospitalization rates were slightly >3 times higher for blacks than whites and 50% higher for males than females. Although an effective vaccine against hepatitis B has

Hepatitis C

The hepatitis C virus was discovered in 1989, and tests for it soon followed. Most prior cases of non-A, non-B hepatitis are believed to have been due to viral hepatitis C. In both the outpatient and inpatient setting, more than half the cases were among persons ages 45–64 years (Table 1). Ambulatory care rates were at least twice as high among blacks as whites and among males as females. Viral hepatitis C was rarely (2.6%) the first-listed diagnosis at hospital discharge, but was frequently

Acute and Chronic Liver Disease

The underlying cause of liver disease is often unclear on administrative data sets. Thus, this report did not break out cause-specific liver disease other than viral hepatitis and hepatocellular carcinoma. Because ICD-10 does not separate acute from chronic liver disease, ICD-9 codes for acute and chronic liver disease were combined to achieve consistency for time trend data.

In 2004, liver disease was the 9th leading digestive disease diagnosis at ambulatory care visits, with 2.4 million visits

Primary Liver Cancer

In this series of articles, frequency, incidence, and survival rates for cancers were extrapolated by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute from its population-based registries. The major malignant neoplasm of the liver is liver cell cancer (hepatocellular carcinoma). Also included in this category were the rare malignancies of hepatoblastoma and angiosarcoma, as well as other primary specified and unspecified liver carcinomas.

Cancer of the Bile Ducts

For this report, intrahepatic and extrahepatic bile duct cancers were combined. In 2004, 22% of bile duct cancer was coded intrahepatic and 45% extrahepatic (including hilar cholangiocarcinoma); nearly all the remainder did not have a location specified. About 6200 cases of bile duct cancer were estimated to have been diagnosed in 2004. Incidence rates were much higher in the oldest age group, with 74% of cases occurring at age ≥65. Age-adjusted rates were highest among Hispanics (2.8 per

Gallstones

This section concerns gallstones (cholelithiasis), either with or without complications (choledocholithiasis, cholangitis, cholecystitis). It does not include acalculous cholecystitis.

In 2004, there were an estimated 1.8 million ambulatory care visits with a diagnosis of gallstones, most of which were for gallstones as a first-listed diagnosis (Table 5). Visit rates increased with age, although only modestly after age 65 years. Age-adjusted rates for any visits were 18% higher among whites than

Cancer of the Gallbladder

About 3000 cases of gallbladder cancer were estimated to have been diagnosed in 2004. Gallbladder cancer was predominantly a diagnosis of the elderly, with a median age of diagnosis of 73 years, the highest of any digestive system cancer (http://seer.cancer.gov/csr/1975_2005/results_merged/topic_med_age.pdf). Gallbladder cancer was the only digestive system malignancy found predominantly among women, who had an age-adjusted rate 75% higher than men. Age-adjusted rates were too low to draw

Pancreatitis

Acute and chronic pancreatitis are grouped together in this section, although acute pancreatitis has the greater burden of medical care and mortality.5 In 2004, there were 475,000 ambulatory care visits as first-listed diagnosis and 881,000 visits as all-listed diagnoses (Table 6). Rates of visits with pancreatitis as all-listed diagnoses increased moderately with age and were higher among blacks than whites and among females than males. Pancreatitis was the 7th most commonly noted digestive

Cancer of the Pancreas

In 2004, >30,000 persons were estimated to have been diagnosed with pancreatic cancer (Table 7). With 71% of these cases diagnosed at ≥65 years old, the age at diagnosis was higher than for most other digestive system cancers, with the median being 72 years and 40% diagnosed at age 75 years or older (http://seer.cancer.gov/csr/1975_2005/results_merged/topic_med_age.pdf). Incidence rates were highest among persons ≥65 years old, non-Hispanic blacks (35% higher than non-Hispanic whites, the

Acknowledgments

The authors thank Danita Byrd-Holt, Bryan Sayer, Sanee Maphungphong, Beny Wu, Laura Fang, Laura Spofford, Polly Gilbert, and Julie Kale of Social & Scientific Systems, Inc, for programming and production of tables and figures; and Dedun Ingram at the National Center for Health Statistics for advice on age adjustment.

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References (5)

  • J.E. Everhart

    Burden of digestive diseases in the United States

  • A. Wasley et al.

    Surveillance for acute viral hepatitis—United States, 2006

    MMWR Surveillance Summary

    (2008)
There are more references available in the full text version of this article.

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Conflicts of Interest The authors disclose no conflicts.

Funding Supported by HHS contracts N267200612918C and N267200700001G.

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