Babajide, O

Abstract Background There is evidence that gastrointestinal disease (GI) outcomes are poorer among patients from underrepresented backgrounds. However, the impact of hospital patient racial diversity on GI outcomes is understudied. Aims We aimed to investigate the impact of hospital patient racial diversity on GI outcomes Methods Using the 2019 National Inpatient Sample (NIS), racial diversity was defined by the percentage of Hispanic or Indigenous American patients discharged from each hospital. GI discharge diagnoses were defined by diagnostic related group. We included GI bleeding, inflammatory bowel diseases, GI obstruction, cirrhosis, and alcoholic hepatitis. Logistic regression was used to predict major complication rates or comorbidity (MCC), long length of stay (LOS), and high total charges. Control variables included age, gender, payer type, patient location, area-associated income quartile, hospital characteristics including size, urban vs. rural, teaching vs. nonteaching, region, and the interaction of the percentage of Hispanic and Indigenous Americans with patient race. Results were validated with the 2018 NIS dataset. Results Our analysis cohort of 537,830 hospitalizations included 252,225 GI bleeding discharges, 59,310 gastrointestinal obstruction discharges, 106,820 cirrhosis and alcoholic hepatitis discharges, and 119,475 inflammatory bowel diseases discharges. In the unadjusted analyses, MCC rates were higher among Hispanic (24.8%) and Indigenous American patients (30.4%), compared to Whites (18.3%). In adjusted analyses, compared to white patients, Hispanic patients had higher MCC rates [adjusted odds ratio (OR) 1.21, 95% Confidence Interval (CI) 1.15-1.28]. The same trend was seen among Indigenous American patients [OR 1.25, (95% CI) 1.09-1.43]. However, as hospital Hispanic diversity increased, inpatient MCC outcomes for Hispanics improved [OR 0.93, (95% CI) 0.87-1.14], and were even better among Indigenous American patients as hospital inpatient Indigenous American diversity increased [OR 0.83, (95% CI) 0.73-0.94] (Table 1). A similar improvement in MCC with increasing Hispanic and Indigenous American diversity was observed in the 2018 validation cohort. Table 1 highlights impact of increasing diversity on LOS and total charges. Conclusions Increasing hospital inpatient Hispanic and Indigenous American diversity is associated with better outcomes for these underrepresented minority groups. More research is needed on the impact of cultural competence and linguistic concordance on patient outcomes. Funding Agencies None

Abstract Background The impact of the Coronavirus disease-2019 (COVID-19) pandemic on patients with liver disease is not well described at the population level in the United States. Purpose We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years. Method Using the National Inpatient Sample (2018-2020), we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality for liver-related indications including compensated cirrhosis, decompensated cirrhosis, alcohol-associated liver disease (ALD), alcohol-associated hepatitis (AH), hepatocellular carcinoma (HCC), and variceal upper gastrointestinal bleeding (VUGIB) using regression modeling. We also looked at the impact of the COVID-19 pandemic on liver transplantation rates. A p-value <0.05 was considered statistically significant. Result(s) Hospitalizations for both compensated and decompensated cirrhosis decreased in 2020 compared to 2019 (relative change [RC] of 1.5%, p <0.001, Table 1). Interestingly, hospitalizations for ALD and AH increased in 2020 compared to pre-pandemic years (ALD RC=15.5% and AH RC 17.0%; p<0.001). Despite the decrease in cirrhosis hospitalizations in 2020, all-cause inpatient mortality among patients with compensated cirrhosis increased from 30,135 in 2019 to 35,220 in 2020 (p<0.001) and from 22,850 in 2019 to 26,390 in 2020 among patients with decompensated cirrhosis (p<0.001). This was accompanied by a 27.8% increase in mortality for ALD (p=0.004) in comparison to pre-pandemic years. Corresponding to the peaks of the pandemic, we observed the fewest cirrhosis hospitalizations in April and December 2020 (Table 2), however, these months had the highest observed mortality rates (p-trend ≤ 0.004). Reassuringly, liver transplantation rates were not significantly impacted by the COVID-19 pandemic (p=0.51). Image Conclusion(s) Cirrhosis hospitalizations, in general, decreased in 2020 compared to pre-pandemic years but were associated with higher all-cause mortality rates particularly in the peak months of the COVID-19 pandemic (April and December 2020) possibly reflecting COVID-19 specific mortality. Alcoholic liver disease admissions also increased during the pandemic while liver transplantation rates were not significant impacted. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared