| アブストラクト | OBJECTIVES: To examine time trends in patient characteristics, care processes and case fatality of first emergency admission for alcohol-related liver disease (ARLD) in England. DESIGN: National population-based, retrospective observational cohort study. SETTING: Clinical Practice Research Datalink population of England, 2008/2009 to 2017/2018. First emergency admissions were identified using the Liverpool ARLD algorithm. We applied survival analyses and binary logistic regression to study prognostic trends. OUTCOME MEASURES: Patient characteristics; 'recent' General Practitioner (GP) consultations and hospital admissions (preceding year); higher level care; deaths in-hospital (including certified cause) and within 365 days. Covariates were age, sex, deprivation status, coding pattern, ARLD stage, non-liver comorbidity, coding for ascites and varices. RESULTS: 17 575 first admissions (mean age: 53 years; 33% women; 32% from most deprived quintile). Almost half had codes suggesting advanced liver disease. In year before admission, only 47% of GP consulters had alcohol-related problems recorded; alcohol-specific diagnostic codes were absent in 24% of recent admission records. Overall, case fatality rate was 15% in-hospital and 34% at 1 year. Case-mix-adjusted odds of in-hospital death reduced by 6% per year (adjusted OR (aOR): 0.94; 95% CI: 0.93 to 0.96) and 4% per year at 365 days (aOR: 0.96; 95% CI: 0.95 to 0.97). Exploratory analyses suggested the possibility of regional inequalities in outcome. CONCLUSIONS: Despite improving prognosis of first admissions, we found missed opportunities for earlier recognition and intervention in primary and secondary care. In 2017/2018, one in seven were still dying during index admission, rising to one-third within a year. Nationwide efforts are needed to promote earlier detection and intervention, and to minimise avoidable mortality after first emergency presentation. Regional variation requires further investigation. |
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| ジャーナル名 | BMJ open |
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| 投稿日 | 2023/11/23 |
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| 投稿者 | Bodger, Keith; Mair, Thomas; Schofield, Peita; Silberberg, Benjamin; Hood, Steve; Fleming, Kate M |
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| 組織名 | Department of Health Data Science, Institute of Population Health, University of;Liverpool, Liverpool, UK kbodger@liverpool.ac.uk.;Gastroenterology Department, Liverpool University Hospitals NHS Foundation Trust,;Liverpool, UK.;Liverpool, Liverpool, UK.;Department of Public Health & Policy, University of Liverpool, Liverpool, UK.;Data & Analytics Transformation Directorate, NHS England, Redditch, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/37993152/ |
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