Gastroenterology

Gastroenterology

Volume 134, Issue 1, January 2008, Pages 85-94
Gastroenterology

Clinical–Liver, Pancreas, and Biliary Tract
Impact of Fatty Liver Disease on Health Care Utilization and Costs in a General Population: A 5-Year Observation

https://doi.org/10.1053/j.gastro.2007.10.024Get rights and content

Background & Aims: Fatty liver disease is a common condition in the Western world. Fatty liver may progress to steatohepatitis and cirrhosis. It is not yet known whether fatty liver disease results in higher health care utilization and costs. Methods: We used data from the Study of Health in Pomerania (SHIP), Germany, to assess the relation of fatty liver disease to self-reported health care utilization and costs at baseline and 5 years. The SHIP is a general population cohort study of 4310 adults aged 20 to 79 years at baseline in Pomerania. Fatty liver disease was defined as the presence of a hyperechogenic pattern of the liver and elevated serum alanine aminotransferase (ALT) levels. Results: In multivariable analyses, average annual overall health care costs at baseline and follow-up measurement were significantly higher for individuals with sonographic fatty liver and increased serum ALT levels. For example, controlling for comorbid conditions, subjects with sonographic fatty liver disease and increased serum ALT levels had 26% higher overall health care costs at 5-year follow-up. Analyses also suggest that diabetes and cardiovascular disease might mediate the relation of fatty liver disease and health care utilization and costs. Conclusions: Policies seeking to minimize costs associated with fatty liver disease might want to consider addressing behavioral risk factors of fatty liver disease.

Section snippets

General Population Sample

Data from SHIP were used.13 The target population was adult (20–79 years of age) German residents of West Pomerania in northeastern Germany. The study area comprised 3 cities and 29 communities with a total population of 212,157 residents. A multistage sampling scheme was adopted from the World Health Organization’s (WHO) MONICA Project, Germany.14 From the total population, a sample of 7008 subjects was drawn from the residents’ registration offices in 1996. The net sample (after exclusion of

Baseline Characteristics of Study Participants by FLD Status

There were 1264 (29.9%) individuals with hyperechogenic pattern of the liver, and 667 (15.8%) had increased serum ALT levels. Among those without hyperechogenic pattern of the liver, 2520 (59.7%) had no increased serum ALT levels, and 440 (10.4%) had increased serum ALT levels (Table 1).

Individuals with liver hyperechogenity or increased serum ALT levels had higher plasma levels of fibrinogen; MCV values; and serum levels of AST, ALT, and GGT than individuals with no liver disorders. Subjects

Discussion

In this study, we examined the relation of FLD and health care utilization and costs based on a prospective cohort of 4224 adults aged 20 to 79 years at baseline and over 5 years. To the best of our knowledge, this is the first study looking at health care use and costs associated with FLD. We found that liver hyperechogenity in combination with elevated serum ALT levels predicts future higher health care costs and utilization, after controlling for socioeconomic, behavioral variables, and

References (28)

  • J.M. Clark

    The epidemiology of nonalcoholic fatty liver disease in adults

    J Clin Gastroenterol

    (2006)
  • G.C. Farrell et al.

    Nonalcoholic fatty liver disease: from steatosis to cirrhosis

    Hepatology

    (2006)
  • H. Volzke et al.

    Hepatic steatosis is associated with an increased risk of carotid atherosclerosis

    World J Gastroenterol

    (2005)
  • H. Volzke et al.

    Menopausal status and hepatic steatosis in a general female population

    Gut

    (2007)
  • Cited by (0)

    Conflicts of interest: No conflicts of interest are declared.

    Supported by the Community Medicine Research net (CMR) of the University of Greifswald, Germany, which is funded by the Federal Ministry of Education and Research (grant ZZ9603), the Ministry of Cultural Affairs, and the Social Ministry of the Federal State of Mecklenburg-West Pomerania.

    The CMR encompasses several research projects that are sharing data of the population-based Study of Health in Pomerania (SHIP; http://ship.community-medicine.de).

    View full text