Sociodemographic disparities in documented nonadherence to medication for hepatic encephalopathy: a National Inpatient Sample analysis

Background Medication nonadherence is often cited as a precipitant of hepatic encephalopathy. However, the underlying reasons and clinical implications of medication nonadherence in this population are understudied. Methods This was a retrospective cross-sectional analysis of hospitalization for hepatic encephalopathy within the National Inpatient Sample from 2016-2022. Multivariate logistic regression analysis was used to assess for patient factors associated with documented nonadherence; results were presented as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Additionally, analysis was performed to assess for associations between documented nonadherence and clinical outcomes. Results Medication nonadherence was documented in 44,685 of the 250,755 (17.8%) hospitalizations for hepatic encephalopathy. Nonadherence was documented more in Black (aOR 1.35, 95%CI 1.24-1.47; P<0.001) and Hispanic (aOR 1.20, 95%CI 1.12-1.28; P<0.001) patients compared to White patients. Substance use diagnoses (aOR 1.36, 95%CI 1.29-1.43; P<0.001) and housing insecurity (aOR 2.47, 95%CI 2.11-2.90; P<0.001) were both associated with documented nonadherence. Discharge against medical advice was more frequent in patients with documented nonadherence (33.8% vs. 18.8%, P<0.001), whereas mortality, need for mechanical ventilation, cost, and length of stay were all less. Conclusions Marginalized populations have higher rates of documented medication nonadherence in cases of hospitalization for hepatic encephalopathy. Structural barriers and provider bias could both be contributing to the documented medication nonadherence in this population.