Gradients in low birthweight by maternal education: A comparative perspective.

Background: Longstanding research has shown strong inequalities in low birthweight by household income. However, most such research has focused on Anglophone countries, while evidence emerging from other developed countries suggest a stronger role of education rather than incomes in creating inequalities at birth. This paper compares gradients in low birthweight by maternal education, as well as explores underlying mechanisms contributing to these gradients, in France, the United States, and the United Kingdom. Methods: Analyses are based on harmonized data from large, nationally-representative samples from France, UK and US. We use regression models and decomposition methods to explore the relative role of several possible mechanisms in producing birthweight inequalities. Results: Inequalities in low birth weight across maternal education groups were relatively similar in the United States, the United Kingdom and France. However, the individual-level mechanisms producing such inequalities varied substantially across the three countries, with income being most important in the US, pregnancy smoking being most evident in France, and the UK occupying an intermediate position. Differences in the mechanisms producing birth health inequalities mirror differences in the policy environment in the three countries. Conclusion: While inequalities in health appear from the earliest moments in many countries, our results suggest research on birth health inequalities, and therefore policies, is not easily generalizable across national contexts, and call for more scholarship in uncovering the "whys" of health inequalities in a variety of contexts.

Older Adults' Unmet Needs at the End of Life: A Cross-Country Comparison of the United States and England.

Objectives: This study aimed to compare the end-of-life (EOL) experiences in concentration with place of death, for older adults in the U.S. and England. Methods: Weighted comparative analysis was conducted using harmonized Health and Retirement Study and English Longitudinal Study of Ageing datasets covering the period of 2006-2012. Results: At the EOL, more older adults in the U.S. (64.14%) than in England (54.09%) had unmet needs (I/ADLs). Home was the main place of death in the U.S. (47.34%), while it was the hospital in England (58.01%). Gender, marital status, income, place of death, previous hospitalization, memory-related diseases, self-rated health, and chronic diseases were linked to unmet needs in both countries. Discussion: These findings challenge the existing assumptions about EOL experiences and place of death outcomes, emphasizing the significance of developing integrated care models to bolster support for essential daily activities of older adults at the EOL.

Prevalence of Immunosuppression Among US Adults.

This analysis presents population prevalence estimates of immunosuppression among US adults using data from the 2021 National Health Interview Survey.

Impact of Intensity of Vascular Care Preceding Major Amputation Among Patients With Chronic Limb-Threatening Ischemia.

BACKGROUND: Lower-limb amputation rates in patients with chronic limb-threatening ischemia vary across the United States, with marked disparities in amputation rates by gender, race, and income status. We evaluated the association of patient, hospital, and geographic characteristics with the intensity of vascular care received the year before a major lower-limb amputation and how intensity of care associates with outcomes after amputation. METHODS: Using Medicare claims data (2016-2019), beneficiaries diagnosed with chronic limb-threatening ischemia who underwent a major lower-limb amputation were identified. We examined patient, hospital, and geographic characteristics associated with the intensity of vascular care received the year before amputation. Secondary objectives evaluated all-cause mortality and adverse events following amputation. RESULTS: Of 33 036 total Medicare beneficiaries undergoing major amputation, 7885 (23.9%) were due to chronic limb-threatening ischemia; of these, 4988 (63.3%) received low-intensity and 2897 (36.7%) received high-intensity vascular care. Mean age, 76.6 years; women, 38.9%; Black adults, 24.5%; and of low income, 35.2%. After multivariable adjustment, those of low income (odds ratio, 0.65 [95% CI, 0.58-0.72]; P<0.001), and to a lesser extent, men (odds ratio, 0.89 [95% CI, 0.81-0.98]; P=0.019), and those who received care at a safety-net hospital (odds ratio, 0.87 [95% CI, 0.78-0.97]; P=0.012) were most likely to receive low intensity of care before amputation. High-intensity care was associated with a lower risk of all-cause mortality 2 years following amputation (hazard ratio, 0.79 [95% CI, 0.74-0.85]; P<0.001). CONCLUSIONS: Patients who were of low-income status, and to a lesser extent, men, or those cared for at safety-net hospitals were most likely to receive low-intensity vascular care. Low-intensity care was associated with worse long-term event-free survival. These data emphasize the continued disparities that exist in contemporary vascular practice.

Forward-Solution Noninvasive Computational Arrhythmia Mapping: The VMAP Study.

BACKGROUND: The accuracy of noninvasive arrhythmia source localization using a forward-solution computational mapping system has not yet been evaluated in blinded, multicenter analysis. This study tested the hypothesis that a computational mapping system incorporating a comprehensive arrhythmia simulation library would provide accurate localization of the site-of-origin for atrial and ventricular arrhythmias and pacing using 12-lead ECG data when compared with the gold standard of invasive electrophysiology study and ablation. METHODS: The VMAP study (Vectorcardiographic Mapping of Arrhythmogenic Probability) was a blinded, multicenter evaluation with final data analysis performed by an independent core laboratory. Eligible episodes included atrial and ventricular: tachycardia, fibrillation, pacing, premature atrial and ventricular complexes, and orthodromic atrioventricular reentrant tachycardia. Mapping system results were compared with the gold standard site of successful ablation or pacing during electrophysiology study and ablation. Mapping time was assessed from time-stamped logs. Prespecified performance goals were used for statistical comparisons. RESULTS: A total of 255 episodes from 225 patients were enrolled from 4 centers. Regional accuracy for ventricular tachycardia and premature ventricular complexes in patients without significant structural heart disease (n=75, primary end point) was 98.7% (95% CI, 96.0%-100%; P<0.001 to reject predefined H0 <0.80). Regional accuracy for all episodes (secondary end point 1) was 96.9% (95% CI, 94.7%-99.0%; P<0.001 to reject predefined H0 <0.75). Accuracy for the exact or neighboring segment for all episodes (secondary end point 2) was 97.3% (95% CI, 95.2%-99.3%; P<0.001 to reject predefined H0 <0.70). Median spatial accuracy was 15 mm (n=255, interquartile range, 7-25 mm). The mapping process was completed in a median of 0.8 minutes (interquartile range, 0.4-1.4 minutes). CONCLUSIONS: Computational ECG mapping using a forward-solution approach exceeded prespecified accuracy goals for arrhythmia and pacing localization. Spatial accuracy analysis demonstrated clinically actionable results. This rapid, noninvasive mapping technology may facilitate catheter-based and noninvasive targeted arrhythmia therapies. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04559061.

The intersection of welfare stigma, state contexts and health among mothers receiving public assistance benefits.

The stigmatizing nature of the US welfare system is of particular importance not only because it has shown to deter eligible applicants from participating in public assistance programs despite facing economic hardship, but also because stigma is an important fundamental cause of health inequities. Although scholars agree stigma is shaped by individual and contextual dimensions, the role of context is often overlooked. Given the heterogeneous nature of US state welfare environments, it may be critical to consider the ways in which state policy, social and economic contexts condition the relationship between welfare stigma and health. Using a multilevel lens, this study first examined the impact of experienced and perceived welfare stigma on self-reported health among female public assistance recipients with children. Second, we assessed the moderating effect of uneven state TANF policies, income inequality, and negative public welfare attitudes in shaping these associations. Using data from the Fragile Families and Child Wellbeing Study merged with state-level economic and social measures, we employed a series of multilevel logit models with random effects. Findings show experiences and perceptions of welfare stigma are significantly linked to poor health regardless of state contexts, and outcomes vary markedly by race, ethnicity and education. States with strong anti-welfare attitudes amplified the relationship between experienced welfare stigma and poor health for Black and Hispanic mothers, and state economic contexts modified the relationship between experienced welfare stigma and poor health for mothers with less than a high school education. TANF generosity had no moderating effect on health suggesting state policy environments have limited ability to protect welfare recipients against the stigmatizing effects of the US welfare system. Results have implications for explaining stigma related disparities in health within the context of U.S. welfare environments and informing policies that may be key levers for reducing health inequities.

Generational Shifts in Young Adult Cardiovascular Health? Millennials and Generation X in the United States and England.

OBJECTIVES: To compare cardiovascular (CV) risks/conditions of Millennials (born 1981-1996) to those of Generation X (Gen X; born 1965-1980) at ages 20-34 years, across 2 countries (United States, England), by gender. METHODS: Using data from the National Health and Nutrition Examination Survey (United States) and Health Survey for England, we estimated weighted unadjusted and adjusted gender-specific proportions of CV risk factors/conditions, separately for Millennials and Generation X in each country. We also further calculated sex-specific generational differences in CV risk factor/conditions by income tercile and for individuals with normal body weight. RESULTS: Millennials in the United States were more obese compared to their Gen X counterparts and more likely to have diabetes risk but less likely to smoke or have high cholesterol. Millennials in England had higher diabetes risk but similar or lower rates of other CV risk/conditions compared to their Gen X counterparts. Generational changes could not be fully attributed to increases in obesity or decreases in income. DISCUSSION: We expected that Millennial CV risk factors/conditions would be worse than those of Gen X, particularly in the United States, because Millennials came of age during the Great Recession and a period of increasing population obesity. Millennials generally fared worse than their Gen X counterparts in terms of obesity and diabetes risk, especially in the United States, but had lower rates of smoking and high cholesterol in both countries. Secular trends of increasing obesity and decreased economic opportunities did not appear to lead to uniform generational differences in CV risk factors.

Reports and Removals of Child Maltreatment-Related Hospitalizations: A Population-Based Study.

Despite U.S. child protective services (CPS) agencies relying on mandated reporters to refer concerns of child maltreatment to them, there is little data regarding which children mandated reporters decide to report and not to report. This study addresses this gap by utilizing a population-based linked administrative dataset to identify which children who are hospitalized for maltreatment-related reasons are reported to CPS and which are removed by CPS. The dataset was comprised of all children born in Washington State between 1999 and 2013 (N = 1,271,416), all hospitalizations for children under the age of three, and all CPS records. We identified maltreatment-related hospitalizations using standardized diagnostic codes. We examined the records for children with maltreatment-related hospitalizations to identify hospitalization-related CPS reports and if the child was removed from their parents. We tested for differences in these system responses using multinomial regression. About two-thirds of children identified as experiencing a child maltreatment-related hospitalization were not reported to CPS. We found differences in responses by maltreatment subtype and the type of diagnostic code. Children whose hospitalizations were related to abuse and associated with a specific maltreatment code had increased odds of being both reported to CPS and subsequently removed by CPS.

Racial-ethnic inequality in cardiovascular health in the United States: Does it mirror socioeconomic inequality?

PURPOSE: To document gender-specific racial-ethnic disparities in cardiovascular (CV) conditions and risk factors net of socioeconomic status (SES) across the lifespan. METHODS: Using pooled data from the 1999 to 2016 U.S. National Health and Nutrition Examination Survey, we document gender-specific proportions of non-Hispanic Whites, non-Hispanic Blacks, and Hispanics ages 12-69 years with various socioeconomic characteristics and CV conditions. We then further disaggregate into 10-year age groups and present unadjusted and SES-adjusted prevalence of each CV condition for each gender/racial-ethnic/age group. RESULTS: Racial-ethnic differences in the prevalence of CV conditions are large for some conditions, emerge early in adulthood, and remain relatively constant though age 69. Only small proportions of the differences can be attributed to differences in SES across groups; attenuation after adjusting for income, education, and available measures of wealth ranged from 0 to 2.3 percentage points. Black-White differences in prevalence of CV conditions differ substantially and systematically by gender; White females have larger advantages or smaller disadvantages (depending on indicator) relative to Black females than White males do relative to Black males. CONCLUSIONS: Racial-ethnic disparities in CV conditions are rooted early in the life course, do not mirror socioeconomic disparities, and vary considerably by gender. Explanations likely involve early life experiences such as racial discrimination and entrenched inequality.

The Incidence of Child Maltreatment Resulting in Hospitalizations for Children Under Age 3 Years.

OBJECTIVE: To assess the incidence of child maltreatment-related hospitalizations for children under 3 years for the population of Washington State. STUDY DESIGN: A population-based study using retrospective linked administrative data for all children born in Washington State from 2000 through 2013 (n = 1 191 802). The dataset was composed of linked birth and hospitalization records for the entire state. Child maltreatment-related hospitalizations were identified using diagnostic codes, both specifically attributed to and suggestive of maltreatment. Incidence were calculated for the population, by birth year, by sex, and by maltreatment subtype. RESULTS: A total of 3885 hospitalizations related to child maltreatment were identified for an incidence of 10.87 per 10 000 person-years. Hospitalizations related to child maltreatment accounted for 2.1% of all hospitalizations for children under the age of 3 years. This percentage doubled over time, reaching a high in 2012 (3.6%). More than one-half of all hospitalizations were related to neglect. Maltreatment-related hospitalizations occurred most frequently in the first year of life for all subtypes except for neglect, which occurred the most between 1 and 2 years of age. Male children had higher incidence than female children in general (11.97 vs 9.70 per 10 000 person-years) and across all subtypes. CONCLUSIONS: Hospitalizations can be a useful source of population-based child maltreatment surveillance. The identification of neglect-related hospitalizations, likely the result of supervisory neglect, because the most common subtype is an important finding for the development of prevention programming.

Incidence and Risk Factors for Abusive Head Trauma: A Population-Based Study.

Previous studies on Abusive Head Trauma (AHT) suggest incidence may vary by geographic location and there is limited information regarding population-based risk factors on this form of child maltreatment. This study provides new knowledge regarding these two aspects using the population of the US state of Washington born between 1999 and 2013. We used a linked administrative dataset comprised of birth, hospital discharge, child protective services (CPS) and death records to identify the scale and risk factors for AHT for the state population using quantitative survival methods. We identified AHT using diagnostic codes in hospital discharge records defined by the US Centers for Disease Control. A total of 354 AHT hospitalisations were identified and the incidence for the state was 22.8 per 100 000 children under the age of one. Over 11 per cent of these children died. Risk factors included a teenaged mother at the time of birth, births paid for using public insurance, child's low birth weight, and maternal Native American race. The strongest risk factor was a prior CPS allegation, a similar finding to a California study on injury mortality. The practice and policy implications of these findings are discussed.

The impact of socioeconomic position (SEP) on women's health over the lifetime.

The "social gradient of health" refers to the steep inverse associations between socioeconomic position (SEP) and the risk of premature mortality and morbidity. In many societies, due to cultural and structural factors, women and girls have reduced access to the socioeconomic resources that ensure good health and wellbeing when compared with their male counterparts. Thus, the objective of this paper is to review how SEP - a construct at the heart of the Social Determinants of Health (SDoH) theory - shapes the health and longevity of women and girls at all stages of the lifespan. Using literature identified from PubMed, Cochrane, CINAHL and EMBASE databases, we first describe the SDoH theory. We then use examples from each stage of the life course to demonstrate how SEP can differentially shape girls' and women's health outcomes compared with boys' and men's, as well as between sub-groups of girls and women when other axes of inequalities are considered, including ethnicity, race and residential setting. We also explore the key consideration of whether conventional SEP markers are appropriate for understanding the social determinants of women's health. We conclude by making key recommendations in the context of clinical, research and policy development.

A Cost-Effectiveness and Quality of Life Analysis of Different Approaches to the Management and Treatment of Localized Prostate Cancer.

The aim of this study was to compare the cost-effectiveness and quality-adjusted life years (QALYs) of active monitoring (AM), radical prostatectomy (PR), and external-beam radiotherapy with neoadjuvant hormone therapy (RT) for localized prostate cancer. Microsimulations of radical prostatectomy, 3D-conformal radiotherapy, or active monitoring were performed using Medicare reimbursement schedules and clinical trial results for a target population of men aged 50-69 years with newly diagnosed localized prostate cancer (T1-T2, NX, M0) over a time horizon of 10 years. Quality-adjusted life years (QALYs) and costs were assessed and sensitivity analyses performed. Monte Carlo simulations revealed that the mean cost for AM, PR, and RT were $15,654, $18,791, and $30,378, respectively, and QALYs were 6.96, 7.44, and 7.9 years, respectively. The incremental cost-effectiveness ratio (ICER) was $6,548 for PR over AM and $68,339 for RT over PR. Results were sensitive to the number of years of follow-up and procedure cost. With relaxed assumptions for AM, the ICER of PR and RT met the societal willingness to pay (WTP) threshold of $50,000 per QALY. Compared with AM, PR was highly cost-effective. RT and PR for localized prostate cancer can be cost-effective, but RT must offer increased QALYs or decreased procedural costs to be cost-effective compared to PR. Newer and cheaper radiotherapy strategies like stereotactic body radiotherapy may play a crucial role in future early prostate cancer management.

Low birth weight and childhood health: the role of maternal education.

PURPOSE: Low birth weight (LBW) is associated with myriad health and developmental problems in childhood and later in life. Less well-documented is the variation in the relationship between LBW status and subsequent child health by socioeconomic status-such as education levels and income. This article examines whether differences exist in the relationship between LBW and subsequent child health by maternal education. METHODS: We used data from the 1998-2017 National Health Interview Survey to estimate multivariate logistic regression models to determine whether the association between LBW and subsequent child health as measured by general health status, developmental disability, and asthma diagnosis differed by maternal education, net of differences in children's sociodemographic factors, family background, and medical access. RESULTS: The negative association between LBW and subsequent health was typically weaker for children of mothers with less than high school education than it was for children of mothers with higher levels of education. CONCLUSIONS: The findings on the enduring impact of LBW status on child health for all children, especially those born to mothers with higher levels of education, suggest that all children born LBW should be provided appropriate medical and support services to reduce the lifelong repercussions of poor health at birth.

Ranolazine Reduces Angina in Women with Ischemic Heart Disease: Results of an Open-Label, Multicenter Trial.

Background: Persistent angina is prevalent in women, who more often present with atypical angina, and experience less relief from antianginal therapies. The impact of ranolazine on female-specific angina is unclear. A single-arm, open-label trial was conducted to quantify the impact of ranolazine on angina in women with ischemic heart disease (IHD). Materials and Methods: Women with IHD and ≥2 angina episodes/week were recruited from 30 U.S. sites. Angina and nitroglycerin (NTG) consumption were assessed using patient-reported diaries, Seattle Angina Questionnaire (SAQ), Duke Activity Score Index (DASI), and Women's Ischemia Symptom Questionnaire (WISQ) at baseline and at 4 weeks of treatment with ranolazine 500 mg twice/day. A modified intent-to-treat analysis and parametric or nonparametric methods were used as appropriate to analyze changes. Results: Of 171 women enrolled, mean age was 65 ± 12 years. Of the 159 women included in the analysis, at week 4 compared to baseline, median angina frequency decreased with ranolazine treatment from 5.0 to 1.5 attacks/week and median change from baseline was -3.3 (95% confidence interval [CI]: -4.0 to -2.5; p ≤ 0.0001). Median NTG consumption decreased from 2.0 to 0.0 per week over the 4 weeks and median change was -1.0 (95% CI: -2.0 to -0.5; p < 0.0001). All five SAQ subscales showed mean improvements: physical limitation 9.2 (standard error [SE] 1.5; p < 0.0001), angina stability 31.8 (SE 2.7; p < 0.0001), angina frequency 17.7 (SE 1.6; p < 0.0001), treatment satisfaction 9.3 (SE 1.6; p < 0.0001), and disease perception 2.9 (SE 0.8; p < 0.0001). DASI score also improved 2.9 (SE 0.8; p = 0.0014). WISQ subscales also showed significant improvements (all p < 0.0001). Thirty-one women reported drug-related adverse events (AEs), predominantly mild to moderate gastrointestinal symptoms. Conclusions: Women with IHD treated with ranolazine for 4 weeks experienced less angina measured by SAQ and WISQ. NTG use decreased, physical activity improved, and treatment satisfaction improved. AEs were consistent with prior reports.

Ninety-day postoperative cost in primary total hip arthroplasty: an economic model comparing surgical approaches.

BACKGROUND: While primary total hip arthroplasty (THA) is a safe and effective procedure, it is unclear whether choice of surgical approach influences health care cost. METHODS: We developed an economic model in which patients receiving THA via the anterior approach (AA) by high volume anterior hip surgeons were compared to a propensity-score matched cohort of primary THA cases performed by high volume surgeons that were identified from Medicare claims (Control). Cost elements included the procedure and hospital stay, postacute care, readmission, and outpatient care through 90 days postoperatively. Costs were derived from Medicare claims and adjusted to account for nationwide payer mix. RESULTS: Health care costs over 90 days postoperative were $17,763 with AA and $23,969 with Control, a difference of $6,206 (95% CI: $5,210-$7,204) per patient. The cost savings with AA were mainly attributable to lower per-patient costs of the index hospitalization ($13,578 vs $16,017), postacute care ($3,123 vs $6,037), and hospital readmissions ($700 vs $1,584). CONCLUSION: The AA for primary THA was found to lower 90-day health care costs when compared to a matched sample of THA cases. These study findings may be used to inform hospitals and health care payers regarding the cost implications associated with selection of different surgical approaches to primary THA.

When richer doesn't mean thinner: Ethnicity, socioeconomic position, and the risk of child obesity in the United Kingdom.

BACKGROUND: A range of studies report a robust association between family socioeconomic position and the prevalence of child overweight/obesity. On average, children from poorer backgrounds are more likely to be overweight/obese than children from more advantaged families. However, a small number of US studies have shown that, for ethnic minority children, the association is either nonexistent or reversed. OBJECTIVE: We test if the link between socioeconomic position and child overweight/obesity at age 7 is heterogeneous in the United Kingdom where rates of obesity are particularly high for some groups of ethnic minority children. METHODS: We use nationally representative data from the UK Millennium Cohort Study as well as descriptive analyses and logistic regression models. RESULTS: Poorer White children are at higher risk of overweight/obesity than higher income White children. However, socioeconomic disparities are reversed for Black African/Caribbean children and nonexistent for children of Indian and Pakistani/Bangladeshi origin. Moreover, the health behaviours that explain socioeconomic disparities in child overweight/obesity for the White group appear to be irrelevant in explaining differences by socioeconomic position for the Black Caribbean and African groups. CONCLUSIONS: We should be careful in assuming that higher socioeconomic position is protective against child overweight/obesity for all groups of the population. CONTRIBUTION: This study shows for the first time important variation by ethnicity in the link between socioeconomic position and child overweight/obesity - and in the underlying mechanisms linking them - in the United Kingdom.

Transdisciplinarity in Research: Perspectives of Early Career Faculty.

BACKGROUND: Early career faculty experiences and perspectives on transdisciplinary research are important yet understudied. METHODS: Assistant professors at 50 top-ranked social work programs completed an online survey assessing perspectives on the salience of transdisciplinary training in their field, obstacles to or negative impacts of transdisciplinary training, and current environments. Content analysis and descriptive statistics were used. RESULTS: A large majority of all participants (N » 118) believed that transdisciplinary research is important, that greater training is needed, and that they are relatively well prepared in related skill sets. They are expected to build cross-disciplinary collaborations, yet only a small minority believed that social work researchers are nationally recognized as important collaborators, or that they are prepared to navigate tensions on research teams. CONCLUSIONS: We offer a multilevel framework of structural and training supports needed to realize transdisciplinary research in social work with relevance to other disciplines.

The relationship between low birthweight and childhood health: disparities by race, ethnicity, and national origin.

PURPOSE: Racial/ethnic disparities in rates of low birthweight (LBW) are well established, as are racial/ethnic differences in health outcomes over the life course. Yet, there is little empirical work examining whether the consequences of LBW for subsequent child health vary by race, ethnicity, and national origin. METHODS: Using data from the 1998-2016 National Health Interview Survey, we examined whether racial, ethnic, and national differences existed in the association between LBW and subsequent health outcomes, namely being diagnosed with a developmental disability, asthma diagnosis, and poorer general health. RESULTS: Children born with LBW consistently had poorer health relative to children born with normal birthweight. There was no systematic evidence that the linkages between LBW and subsequent health were weaker for one racial/ethnic/national origin group relative to others. CONCLUSIONS: LBW was associated with subsequent poorer health. There was no systematic evidence that the link between LBW and subsequent child health were weaker for one racial/ethnic/national origin group relative to others. Together, these findings highlight the importance of reducing race/ethnic disparities in rates of LBW as a way of eradicating inequalities in childhood health.

Mortality and costs associated with alcoholic hepatitis: A claims analysis of a commercially insured population.

Rising mortality in the United States due to alcoholic liver disease (ALD) and the dearth of effective treatments for ALD have led to increased research in this area, particularly in alcoholic hepatitis. To understand the burden of illness and potential economic value of effective treatments, we conducted a health care claims analysis of over 15,000 commercially insured adults who were hospitalized with alcoholic hepatitis (AH) between 2006 and 2013 and followed for up to 5 years. Their average age was 54 years and 68% were male. Over 5 years, about two-thirds of these adults died (44% in the first year), and fewer than 500 received liver transplants. There were nearly 40,000 re-hospitalizations, with over 50% of the survivors re-hospitalized within a year and nearly 75% through the second year. The total costs were nearly $145,000 per patient, with costs decreasing over time from over $50,000 in the first year (including the index hospitalization) to about $10,000 per year in the later years. Total costs for the cohort over 5 years were $2.2 billion. Patients who received a liver transplant averaged about $300,000 in transplant-related costs and over $1,000,000 in total health care costs over 5 years. Average costs in years following the index hospitalization were similar to diabetes. AH has a high mortality and is a high-cost condition.