ObjectivesEffective oral therapies for hepatitis B and C have recently been developed, while there are no approved pharmacological therapies for alcoholic and non-alcoholic fatty liver diseases (ALD and NAFLD). We hypothesise that fewer advances in fatty liver diseases could be related to disparities in research attention.MethodsWe developed the Attention-to-Burden Index (ABI) that compares the research activities during 2010–2014, and an estimate of disease burden of these 4 major liver diseases. The resulting ratio reflects either overattention (positive value) or inadequate attention (negative value) compared with disease burden. The mean research attention and disease burden were calculated from 5 and 6 different parameters, respectively. The efficacy rate of current pharmacological therapies was assessed from published clinical trials.FindingsThe mean research attention for hepatitis B and C was 31% and 47%, respectively, while NAFLD and ALD received 17% and 5%. The overall burden was 5% and 28% for hepatitis B and C, and 17% and 50% for NAFLD and ALD. The calculated ABI for hepatitis B and C revealed a +6.7-fold and +1.7-fold overattention, respectively. NAFLD received an appropriate attention compared with its burden, while ALD received marked inadequate attention of −9.7-fold. The efficacy rate of current pharmacological agents was 72% for hepatitis B, 89% for hepatitis C, 25% for non-alcoholic steatohepatitis and 13% for alcoholic hepatitis. Importantly, we found a positive correlation between the mean attention and the efficacy rate of current therapies in these 4 major liver diseases.InterpretationThere are important disparities between research attention and disease burden among the major liver diseases. While viral hepatitis has received considerable attention, there is a marked inadequate attention to ALD. There is a critical need to increase awareness of ALD in the liver research community.
years, 64% were male, 89% were white, 32% had received college or higher education and 66% had private insurance. 59% patients died in hospice (36% in inpatient hospice, and 23% in home hospice) and 40% in the hospital (23% in ICU and 17% on the floor). Figure shows indicators of intense EOL care in patients who died in hospital vs. hospice. Median duration of hospice was 3 (range 1-41) days. 72% had an advance directive on record and 37% were seen by palliative medicine. There was a higher rate of mechanical ventilation (p<0.001) and use of invasive procedures (p=0.01) in the last week of life for those that died in the hospital vs. in hospice. In the multivariable model, female gender (OR: 0.27, 95% CI: 0.10 to 0.7, p=0.01) and having an advance directive on record (OR: 0.24, 95% CI: 0.07 to 0.80, p=0.02) were associated with decreased odds of having >1 intensive care indicators. Conclusions: There is a high utilization of intensive care and procedures in the last days of life for patients dying in the hospital. Patients with advance directives were more likely to experience a value based EOL care including avoidance of intensive, and ultimately futile, medical care.
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