RESUMO
Background and aim: Autoimmune hepatitis (AIH) is a prominent cause of chronic liver disease in the United States. This study aims to characterize the incidence, mortality, and cost implications of this condition using a national database. Method: The 2016-2019 National Inpatient Sample was used to select patients with AIH. After adjusting for inflation, weighted charge data were used to calculate the admission costs using charge-to-cost ratios. Demographic, socioeconomic status, and comorbidity values were used to build strata to characterize admission incidence, mortality data and aggregate and per-capita cost values. Furthermore, additional sensitivity analysis was performed using a stratified set of patients with AIH as one of the top 10 diagnosis (AIH-specific subsample). Multinomial regression curves were graphed and assessed to derive goodness-of-fit for each trend. R2 and P-values were calculated. Results: From 2016 to 2019, the total admissions related to AIH were approximately 20,984, 21,905, 22,055, and 22,680 cases, respectively (R2: 0.93, P-value: 0.03). AIH-related hospitalization aggregate costs came to $338.18, $369.17, $355.98, and $387.25 million dollars (R2: 0.75, P-value: 0.17). Significant admission growth was seen in the Southern region (R2: 0.91, P-value: 0.05). Most notably, increasing trends in total admissions were found across older age, those of White and Hispanic descent, and those with comorbidities. On the other hand, the AIH-specific subsample illustrated decreasing trends in admissions across demographics (i.e., age, gender, and race) and comorbidities; however, those with hepatic complications saw a rise in the admission trends (cirrhosis - R2: 0.98, P-value: 0.009; multiple liver complications - R2: 0.95, P-value: 0.03). Conclusion: Among AIH-specific admissions, there was a decreasing trend overall; however, there was an exceptional increase in the admissions among those with hepatic complications.
RESUMO
COVID-19 has underlined the critical importance of bringing biosocial and biopsychosocial approaches to pre-health education. Given the striking social inequalities that the pandemic has both exposed and exacerbated, we argue that bridging between the biomedical and social sciences with such approaches is now more appropriate and urgently needed than ever. We therefore call for the re-socialization of pre-health education by teaching to develop socio-structural competencies alongside physical and biological science knowledge. We suggest that community partnerships, which address local inequalities and their global interdependencies, should be encouraged as an essential element in all pre-health education. Educators should also support such partnerships as opportunities for students who come from more minoritized and impoverished social backgrounds to see their own social knowledge-including community-based knowledge of health-injustices revealed by the pandemic-as the basis of biopsychosocial expertise. By prioritizing this reconceptualization of pre-health education, we can empower future health workers to prepare more adequately for future health crises in ways that are socially aware and structurally transformative.
