Abstract
BACKGROUND: Additional hepatologists are required to manage the rapidly increasing number of patients with liver disease. One disincentive to trainees considering a career in hepatology is the longstanding perception that outpatient hepatology consists largely of managing patients with alcohol-induced liver disease (ALD). OBJECTIVES: To document the types of liver diseases and changes in liver disease referrals to an urban outpatient liver disease clinic over the past 25 years. METHODS: The nature of the liver disorder, age, gender, and socioeconomic status of patients referred to an urban, hospital-based, liver diseases outpatient program were documented from 1992 to 2017. Joinpoint analysis was performed to identify significant trends in referral prevalence rates of various disorders. RESULTS: In 1992/1993, hepatitis C virus (HCV), followed by hepatitis B virus (HBV), "other", non-alcoholic fatty liver disease (NAFLD), and primary biliary cholangitis (PBC) were the most common underlying liver diseases in referred patients (39, 36, 12, 4.5, and 3.5% respectively), whereas in 2016/2017, NAFLD, HBV, HCV, "other," and ALD were most common (60, 15, 12, 8.7, and 3.3%, respectively). Aside from NAFLD referrals, which consistently increased over the 25-year period, the prevalence of all other liver disease referrals fluctuated but generally declined. Recently referred patients were significantly older (38 ± 13 years in 1992/1993 and 49 ± 15 years in 2016/2017, P < 0.0001), while gender and socioeconomic status have not changed. CONCLUSIONS: Hepatology is a diverse, dynamic subspecialty where ALD continues to constitute less than 5% of all patient referrals.