Burden, healthcare utilization, and costs of chronic liver disease–related hospitalizations in California: a population-based study of trends and projections, 2005–2035

Background Long-term trends in hospitalization burden, healthcare utilization, and costs of chronic liver disease (CLD) in the United States remain poorly characterized. Using statewide hospital discharge data, we quantified trends from 2005 to 2018 and projected future burden through 2035 across demographic subgroups. Methods We used average annual percent change (AAPC) to quantify trends in hospitalized patients, hospitalizations, deaths, along with age-standardized rates (ASHPR, ASHR, and ASMR); hospitalizations per patient-year, average length of stay, 30-day readmission, in-hospital mortality; and inflation-adjusted hospital charges (2019 US dollars). Analyses were conducted overall and for hepatitis B virus(HBV), hepatitis C virus(HCV), alcohol-associated liver disease(ALD), and metabolic dysfunction-associated steatotic liver disease (MASLD). Findings From 2005 to 2018, hospitalized CLD patients increased from 71,214 to 122,810 (AAPC, 4.37%; 95% CI, 3.87%–4.88%), and deaths from 11,455 to 24,560 (6.02%; 4.20%–7.86%). ASHPR increased from 275.12 to 377.88 per 100,000, and ASMR from 45.53 to 74.77. Hospitalizations and charges increased from 116,482 to 185,268 and $9.63 billion to $18.63 billion, while in-hospital mortality declined (AAPC, −7.02%; 95% CI, −8.72%–5.30%). MASLD- and ALD-related hospitalizations increased, whereas HBV- and HCV-related hospitalizations declined. Men had higher hospitalization and mortality rates, particularly for ALD. Hispanic populations had the fastest-rising burden, driven by MASLD; HBV burden was concentrated among non-Hispanic Asian populations, whereas overall CLD and ALD-related mortality were highest among non-Hispanic White populations. Interpretation Findings highlight the need for targeted prevention and screening, early management of metabolic and alcohol-related risk factors, and equitable access to liver care. Funding No funding.