Duseja, Nikhil

Portal hypertension is a central driver of morbidity and mortality in advanced chronic liver disease, yet its contribution to death is frequently underestimated owing to underreporting on death certificates. Population-level data on portal hypertension-related mortality trends and disparities in the United States remain limited. We conducted a retrospective, population-based mortality study using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database, identifying deaths with International Statistical Classification of Diseases and Related Health Problems, 10th Revision code K76.6 listed in any cause-of-death field from 1999 to 2023. Crude and age-adjusted mortality rates per 100,000 population were calculated and stratified by sex, U.S. Census region, race/ethnicity, and urban–rural status (the latter restricted to 1999–2020 due to data availability). Temporal trends were assessed using Joinpoint regression, with annual percent change (APC) reported as the primary trend metric and 95% confidence intervals presented for all estimates. A total of 34,551 portal hypertension-related deaths were identified. Overall age-adjusted mortality rates declined sharply from 1999 to 2002 (APC − 12.85%), plateaued for more than a decade, and rose thereafter. Mortality increased significantly in women after 2009 (APC + 6.69%) and in men after 2013 (APC + 6.18%). Among racial and ethnic groups, Hispanic or Latino individuals consistently demonstrated the highest mortality burden throughout the study period, followed by White individuals, whereas Black or African American individuals exhibited comparatively lower but significantly rising rates from 2006 onward. White individuals demonstrated the steepest recent acceleration, with a significant increase after 2014 (APC + 8.51%). Regionally, the South experienced the steepest post-2013 increase, while the Northeast retained the lowest absolute rates despite a significant rise after 2014. Urban populations showed early improvement through 2014 followed by rising mortality, whereas rural populations experienced a later but steeper rise beginning around 2013, with widening urban–rural disparities over time. Portal hypertension-related mortality has risen significantly since the mid-2010s across all demographic and geographic subgroups, with disproportionate burdens among Hispanic individuals, men, rural populations, and residents of the Southern United States. These findings highlight the urgent need for targeted prevention strategies, equitable access to hepatology care, and aggressive management of metabolic and alcohol-related risk factors to reverse this trajectory.

Introduction: This study evaluated the impact of parallel-level patient transfers on bed utilization efficiency within the Mayo Clinic Health System in Southern Minnesota, focusing on optimizing resources across tertiary and critical access hospitals. Methods: A retrospective analysis of 179,066 Emergency Department visits (2018–2022) was conducted, with ~2% involving parallel-level transfers for observation or admission. Machine learning was utilized to identify patients suitable for parallel transfers based on demographics, comorbidities, and clinical factors. A Random Forest model with an AUROC of 0.87 guided transfer decisions. Saved patient days were calculated as the difference between the actual LOS and the benchmark LOS based on Diagnosis-Related Groups (DRGs). Generalized estimating equations analyzed length of stay (LOS) differences, adjusted for confounders, with 95% confidence intervals (CI). Statistical analyses were conducted using SPSS (v.26). Results: The mean patient age was 56 years (SD = 17.2), with 51.4% being female. Saved patient days increased from ~600 to 5200 days over the study period. Transferred patients had a 5.7% longer unadjusted LOS compared to non-transferred patients (95% CI: 2.9–8.6%, p < 0.001). After adjustment for demographics and comorbidities, the LOS difference was not significant (adjusted mean difference: 0.4%, 95% CI: −1.7–2.5%, p = 0.51). Conclusions: Parallel-level transfers increased saved patient days, reflecting enhanced resource utilization. However, the adjusted LOS differences were not significant, highlighting the need for robust transfer protocols and controlled studies to confirm these findings.