- Case study with electronic health record (EHR) without identification from 360 hospitals and 317,000 healthcare providers from 50 states from 1999 to present times to represent about 20% of the US population
- Data collected from databases is then normalized using systematized nomenclature for clinical term for liver disease/damage and then aggregated 
- The status of liver disease was based on 6 non overlapping classifications including:  alcoholic cirrhosis, non alcoholic cirrhosis, chronic non alcoholic liver disease, chronic Hepatitis C, Viral Hepatitis B, and alcoholic liver damage

Database Description: COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States

The study population of this analysis consists of the 1,034,270 patients that had contact with the US healthcare system for a diagnosis of CLD, 16,530 patients with COVID-19 and 820 people with COVID-19 and CLD. According to the CDC and American Association for the Study of Liver Diseases, people with CLD may be at increased risk for getting COVID-19. As a result this study was done focusing on three things. The first part of the study was to compare the odds of COVID-19 diagnosis in patients with CLD to those without CLD adjusted for race, age, gender and other known COVID-19 comorbidities and risk factors. Next was to see how age, gender and race further impacted the COVID-19 risk for those with CLD. For example case groups of patients with CLD that are female, over 65 or African American were studies with comparison groups that were male, under 65 or Caucasian. The last part of this study was to compare death rates and hospitalizations for COVID-19 patients with no CLD and recent CLD encounters over the span on 8 months.

Study Population: COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States

For the studies of the odds of COVID-19 diagnosis in patients with and without CLD and the effect of age, gender, and race on COVID-19 risk with CLD, the Cochran Mantel Haenszel method was used to calculate multiple factors. The adjusted odds ratio, 95% Cl and p values were calculated with control for age, gender, race and other COVID-19 risk factors. For the portion of the study pertaining to death and hospitalization rates over 8 months for COVID patients with and without CLD a two sided two sample test was done with continuity correction for comparison of the rates.

Statistical Analysis: COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States

- Database description
- Study Population
- Statistical Analysis

Rutgers University

There have been limited studies for patients with chronic liver disease (CLD), including cirrhosis, Hep B, Hep C and chronic non alcoholic liver disease, in determining the risk associated with COVID-19. Further effects of age, race and gender have also not been studied as it pertains to CLD. What is known, however is that the coronavirus can damage the liver and higher mortality rates have been associated with CLD. Furthermore, people with CLD often have abnormal immune function, systemic inflammation, and/or other COVID-19 comorbidities causing an overlap of risk factors. 

COVID-19 risk with chronic liver disease in the United States

Methods: COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States

- Patients with the highest odds for getting COVID-19 were those with chronic non alcoholic liver disease and non alcoholic cirrhosis followed by chronic Hep C, alcoholic liver damage, alcoholic cirrhosis and finally chronic Hep B
- Hospitalization rate for 16,530 adult COVID patients was 24.3% higher for African Americans than Caucasians
- Of 390 people with COVID-19 and a recent CLD encounter, 41.0% were hospitalized and 10.3% died
- There was a higher death and hospitalization rate in African Americans in comparison to Caucasians and in those with CLD and COVID-19 in comparison to those without CLD

Results: COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States

- Patients with CLD especially with a recent encounter with CLD in the past year were at a significantly higher risk for COVID-19 compared to those without CLD
- African Americans with CLD were 2x more likely to get COVID-19 than Caucasians
- COVID-19 patients with CLD had increased rates of hospitalization and death than people that are COVID-19 negative with CLD and those that were positive without CLD
- Limitations to the study due to use of patient EHR data for analysis:
     (1) possible under diagnosis, misdiagnosis, over diagnosis, and limited information 
regarding treatments and medications the patients are undergoing;
     (2) no detailed information on the socioeconomics and geographic of the patient 
population;
     (3) no representation for all of the US or for other countries just documented 
encounters with CLD in the US healthcare system

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