S2492 Disparities in Mortality Among Acute Liver Failure Patients: The Impact of Insurance Status and Income Level in a National Cohort Analysis

Introduction: Acute liver failure (ALF) is a life-threatening clinical syndrome characterized by rapid deterioration of liver function in individuals without preexisting liver disease. ALF is associated with high morbidity and mortality and often necessitates intensive care management and, in many cases, liver transplantation. This study investigates the impact of income level and insurance status in ALF patients through a national cohort analysis. Methods: We conducted a retrospective analysis of the National Inpatient Sample (NIS) database from 2019 to 2021. Patients hospitalized with a primary diagnosis of acute liver failure were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Patient demographic data were stratified by income quartile and payer type to assess socioeconomic disparities. Income was categorized into 4 quartiles: quartile 1 (≤$43,000), quartile 2 ($44,000-$55,900), quartile 3 ($56,000-$73,000), and quartile 4 (≥$74,000). Insurance coverage was categorized into Medicare, Medicaid, private insurance, and self-pay. Multivariate logistic was used to adjust for confounders. The primary outcome was inpatient mortality. STATA software was utilized for statistical analysis. Results: Among 591,435 patients with acute liver failure, 223,976 (37.9%) died during hospitalization or treatment. Income distribution among patients was skewed toward lower-income groups, with 32% in quartile 1 and only 18% in quartile 4. Inpatient mortality was highest in quartile 1 (37.3%) and quartile 4 (36.9%), with a statistically significant difference in outcomes across income groups (P = 0.029). In respect to insurance status, 50.5% were covered under Medicare, 21.7% under private insurance, 19.3% by Medicaid, and 5.0% were self-paying. Self-pay patients had the highest mortality (39.9%), followed by Medicare (39.4%), private (34.6%), and Medicaid (30.8%). The variation in mortality by payer type was statistically significant (P < 0.0001). Conclusion: This large-scale analysis reveals that socioeconomic factors-particularly income and insurance status-are significantly associated with mortality in ALF patients. Lower-income and those lacking comprehensive insurance coverage, especially self-pay individuals, experience disproportionately higher mortality. These results highlight the need for healthcare policies that address these disparities by improving access to high-quality care for vulnerable populations. By targeting such socioeconomic disparities, healthcare systems can improve outcomes and equity in the management of ALF.