S1293 Prevalence and Trends in Hospitalizations for Suicidal Ideation, Suicide, and Self-Inflicted Harm Among Patients With Cirrhosis: A Nationwide Analysis
Bibliographic record
Abstract
Introduction: Chronic illnesses have been associated with suicidal ideation (SI), suicide and self-inflicted harm (S/SIH). However, suicidality in patients with cirrhosis is understudied. We sought to describe trends, predictors, and outcomes of SI and S/SIH among hospitalized patients with cirrhosis, using a nationally representative dataset. Methods: Using the 2007-2014 Nationwide Inpatient Sample, we determined trends in cirrhosis-related SI and S/SIH hospitalizations. We compared baseline characteristics between patients with cirrhosis hospitalized with SI and S/SIH vs. those without suicidality. Multivariable regression analysis was used to identify patient-level predictors of SI and S/SIH. We also compared outcomes including all-cause inpatient mortality, hospital length of stay (LOS), and costs Results: Suicidal ideation and S/SIH-related hospitalizations accounted for 1.2% of all cirrhosis admissions. Hospitalizations for SI increased steadily while those for S/SIH decreased after peaking in 2010 (Figure). The majority of SI and S/SIH hospitalizations occurred in men, Medicaid patients, and among individuals with depression and anxiety [Table]. On multivariable analysis, older age (adjusted odds ratio [aOR] 0.12, 95% Confidence Interval [C.I.] 0.1-0.13), female sex (aOR =0.77, 95%CI= 0.78-0.81), and private payer status (aOR =0.58, 95%CI= 0.54-0.63) were associated with lower odds of SI and S/SIH. Blacks (aOR=0.55, 95%CI=0.5-0.6) and Hispanics (OR=0.63, 95%CI= 0.57-0.7) had significantly lower odds of suicidality compared to White patients. While patients from lower ecological socioeconomic groups, those on Medicaid (aOR=1.21, 95%CI=1.13-1.29), and those with comorbid depression (aOR=1.63, 95%CI=1.52-1.75) and anxiety (aOR=2.58, 95%CI=2.41-2.76) had higher adjusted odds of suicidality. All-cause inpatient mortality was lowest among patients with SI (0.6%) compared to those with S/SIH (2.7%). In addition, patients with SI had longer LOS than those without SI (6.7 vs 6.0 days, p=0.012). Hospital costs were also significantly lower for those with SI ($8270) compared to those with S/SIH ($12376) [Table]. Conclusion: In this nationally representative cohort, we observed a rising trend in suicidal ideation among patients with cirrhosis especially patients who were younger, White, from lower socioeconomic backgrounds, with comorbid anxiety and depression. Hospitalizations for suicide and self-inflicted harm appeared to be on the downtrend.Figure 1.: Suicidal ideation and S/SIH-related hospitalizations Table 1. - Baseline characteristics of patients with cirrhosis hospitalized for suicidal ideation, suicide and self-inflicted harm None Suicidal ideation Suicide and self-inflicted harm P-value Weighted, n 3990744 35759 11245 Age in years, mean (SD) 58.4 (0.06) 50.7 (0.13) 49.3 (0.21) < 0.001 Age groups < 0.001 18-39 204102 (5.1%) 3997 (11.2%) 1559 (13.9%) 40-64 2636301 (66.1%) 29648 (82.9%) 9187 (81.7%) 65-74 716164 (17.9%) 1747 (4.9%) 411 (3.7%) ≥75 434176 (10.9%) 367 (1.0%) 87 (0.8%) Sex < 0.001 Male 2446171 (61.3%) 24931 (69.7%) 6884 (61.2%) Female 1544233 (38.7%) 10823 (30.3%) 4360 (38.8%) Race < 0.001 White 2370145 (59.4%) 23702 (66.3%) 7686 (68.3%) Black/African American 392633 (9.8%) 2702 (7.6%) 628 (5.6%) Hispanic 620323 (15.5%) 4491 (12.6%) 1210 (10.8%) Others/Missing 607642 (15.2%) 4863 (13.6%) 1721 (15.3%) Primary payer < 0.001 Medicare 1714242 (43.1%) 10978 (30.8%) 3247 (29.0%) Medicaid 895128 (22.5%) 13167 (36.9%) 3703 (33.0%) Private insurance 865167 (21.7%) 5079 (14.3%) 2055 (18.3%) Self-pay 302638 (7.6%) 3874 (10.9%) 1317 (11.7%) No charge 34306 (0.9%) 499 (1.4%) 193 (1.7%) Other 169630 (4.3%) 2040 (5.7%) 699 (6.2%) Hospital size 0.389 Small 460791 (11.6%) 4277 (12.0%) 1232 (11.0%) Medium 984649 (24.8%) 8529 (24.0%) 3029 (27.2%) Large 2522795 (63.6%) 22709 (63.9%) 6889 (61.8%) Income < 0.001 Q1 1292454 (33.5%) 13066 (38.4%) 3819 (35.4%) Q2 1021754 (26.5%) 8568 (25.2%) 3091 (28.7%) Q3 875772 (22.7%) 7368 (21.7%) 2341 (21.7%) Q4 664196 (17.2%) 4999 (14.7%) 1527 (14.2%) Comorbidity index < 0.001 0 30683 (0.8%) 19 (0.1%) 11 (0.3%) 1-3 1428084 (35.8%) 13287 (37.2%) 2835 (25.2%) >3 2531977 (63.4%) 22453 (62.8%) 8409 (74.8%) Depression 468865 (11.7%) 7357 (20.6%) 3047 (27.1%) < 0.001 Anxiety 246203 (6.2%) 6831 (19.1%) 1768 (15.7%) < 0.001 All-cause inpatient mortality 251739 (6.3%) 223 (0.6%) 300 (2.7%) < 0.001 Length of stay (in days) 6.0 (0.02) 6.7 (0.09) 5.6 (0.16) 0.012 s 15409 8270 12376 < 0.001
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".