Search

Background & Aims Gastrointestinal (GI), liver, and pancreatic diseases are a source of substantial morbidity, mortality, and cost in the United States. Quantification and statistical analyses of the burden of these diseases are important for researchers, clinicians, policy makers, and public health professionals. We gathered data from national databases to estimate the burden and cost of GI and liver disease in the United States. Methods We collected statistics on health care utilization in the ambulatory and inpatient setting along with data on cancers and mortality from 2007 through 2012. We included trends in utilization and charges. The most recent data were obtained from the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the National Cancer Institute. Results There were 7 million diagnoses of gastroesophageal reflux and almost 4 million diagnoses of hemorrhoids in the ambulatory setting in a year. Functional and motility disorders resulted in nearly 1 million emergency department visits in 2012; most of these visits were for constipation. GI hemorrhage was the most common diagnosis leading to hospitalization, with >500,000 discharges in 2012, at a cost of nearly $5 billion dollars. Hospitalizations and associated charges for inflammatory bowel disease, Clostridium difficile infection, and chronic liver disease have increased during the last 20 years. In 2011, there were >1 million people in the United States living with colorectal cancer. The leading GI cause of death was colorectal cancer, followed by pancreatic and hepatobiliary neoplasms. Conclusions GI, liver and pancreatic diseases are a source of substantial burden and cost in the United States.

Background: The number of liver transplants performed in the US increased annually until 2006, but has since declined despite ongoing increases in demand. One possible reason for this decline is a reduction in donor organ utilization as a result of decreased organ quality. We aimed to (1) evaluate the association between various donor characteristics and organ discard and (2) examine trends over time in these characteristics that may explain any increased discard rate. Methods: We performed a retrospective cohort study using the United Network for Organ Sharing database comprising all donors ≥ 18 years old who successfully donated at least one organ between 1994 and 2010. Living donors, split livers, and donors with a body mass index (BMI) 50 kg/m2 were excluded. Multivariable logistic regression was used to evaluate the association between donor characteristics and the discard of donor livers. Population attributable risk proportions were determined to estimate the contribution of various donor factors to liver discard. Results: Of 93,232 organ donors, 69,833 (75%) livers were used, and 23,399 (25%) went unused. The number of discarded organs was stable until 2003, and then increased from 1,058 (19%) in 2003 to 1,828 (26%) in 2010. In bivariate analysis, discarded livers were more often from donors who were older (median 49 vs. 43 years). Rates of discard were higher in donors with obesity (35% vs. 22% of non-obese donors), diabetes (DM) (35% vs. 24% of non-diabetics), hypertension (HTN) (31% vs. 22% of normotensive donors), and donation after cardiac death (DCD) (65% vs. 22% of non-DCD). In the multivariable model, discarded livers were associated with donor age (OR 1.03 for each year increase, 95% CI 1.03-1.04), obesity (OR 1.92, 95% CI 1.82-2.03), DM (OR 1.42, 95% CI 1.32-1.53), HTN (OR 1.15, 95% CI 1.081.22), and DCD (OR 12.3, 95%CI 11.3-13.4). Between 1994 and 2010, there were significant increases in the median donor age (40 to 46) and the prevalence of obesity (13% to 31%), DM (3% to 13%), HTN (22% to 39%), and DCD (2% to 12%). In 2010, 44% of non-use was due to increased age, 9% to obesity, 5% to diabetes, and 5% to hypertension. These proportions were stable over time. In contrast, the proportion discarded due to DCD rose dramatically from 0.2% in 2000 to 26% in 2010. The OR for DCD liver discard also increased from 1.80 to 25.0 reflecting increasing reluctance to use these grafts. Conclusions: Organ donors are increasingly older, with more obesity, DM, and HTN, all of which may limit expansion of the donor pool. DCD is becoming more common, but its ability to expand the donor pool is significantly hindered by an increasing discard rate. Indeed, if the DCD option is taken merely as an alternative to donation after brain death, then more DCD will lead to a significant decline in usable grafts.