County Differences in Liver Mortality in the United States: Impact of Sociodemographics, Disease Risk Factors, and Access to Care

Goldberg, David S.; Ross-Driscoll, Katie; Lynch, Raymond

doi:10.1053/j.gastro.2020.11.016

Cited by 28 publications

(26 citation statements)

References 49 publications

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“…In addition, patients with cirrhosis may experience excess mortality in rural hospitals, potentially because of reduced access to hepatology specialists in rural areas (11,12). Recent work by Goldberg et al (13) has shown that the disproportionate liver disease-associated mortality in rural areas may be due in part to distance from liver transplantation centers. Our findings, however, of increased cirrhosis mortality among middle-aged Americans in all regions suggest access to care is not the only contributing factor.…”

Section: Discussionmentioning

confidence: 99%

Rural-Urban Disparities in Mortality From Cirrhosis in the United States From 1999 to 2019

et al. 2022

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INTRODUCTION: We examined trends in rural-urban cirrhosis mortality disparities in the United States from decedents aged 25 years and older from 1999 to 2019. METHODS:We calculated cirrhosis age-adjusted mortality rates across 3 population categories: large metropolitan ( ‡1 million), medium/small metropolitan (50,000-999,999), and rural (<50,000) areas using the US Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database. RESULTS:We found an almost 20-fold increase in the absolute difference in cirrhosis age-adjusted mortality rates between rural and large metropolitan areas between 1999 and 2019.DISCUSSION:Future research is needed to investigate reasons for this widening rural-urban disparity to improve rural cirrhosis care.

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Section: Discussionmentioning

confidence: 99%

Rural-Urban Disparities in Mortality From Cirrhosis in the United States From 1999 to 2019

et al. 2022

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“…Although integrated systems of care such as the VA or Kaiser Permanente contain detailed granular data on disease incidence and prevalence, this only represents a small part of the US population. Studies have begun to examine liver disease–related mortality at the population level; more work such as this is needed in LT. ( 60 ) Most US ambulatory practices and acute care hospitals are serviced by a handful of large EHR vendors. ( 61 ) Paramount to reducing health care disparities are national efforts and partnerships to improve data access, transparency, and widespread use for clinical care, research, and public health.…”

Section: Setting Up a Research Agenda To Study Disparities In Transplantationmentioning

confidence: 99%

Racial, Gender, and Socioeconomic Disparities in Liver Transplantation

Nephew

Serper

2021

Liver Transpl.

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Liver transplantation (LT) is a life‐saving therapy; therefore, equitable distribution of this scarce resource is of paramount importance. We searched contemporary literature on racial, gender, and socioeconomic disparities across the LT care cascade in referral, waitlist practices, allocation, and post‐LT care. We subsequently identified gaps in the literature and future research priorities. Studies found that racial and ethnic minorities (Black and Hispanic patients) have lower rates of LT referral, more advanced liver disease and hepatocellular carcinoma at diagnosis, and are less likely to undergo living donor LT (LDLT). Gender‐based disparities were observed in waitlist mortality and LT allocation. Women have lower LT rates after waitlisting, with size mismatch accounting for much of the disparity. Medicaid insurance has been associated with higher rates of chronic liver disease and poor waitlist outcomes. After LT, some studies found lower overall survival among Black compared with White recipients. Studies have also shown lower literacy and limited educational attainment were associated with increased posttransplant complications and lower use of digital technology. However, there are notable gaps in the literature on disparities in LT. Detailed population‐based estimates of the advanced liver disease burden and LT referral and evaluation practices, including for LDLT, are lacking. Similarly, little is known about LT disparities worldwide. Evidence‐based strategies to improve access to care and reduce disparities have not been comprehensively identified. Prospective registries and alternative “real‐world” databases can provide more detailed information on disease burden and clinical practices. Modeling and simulation studies can identify ways to reduce gender disparities attributed to size or inaccurate estimation of renal function. Mixed‐methods studies and clinical trials should be conducted to reduce care disparities across the transplant continuum.

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“…During the past 5 years, Gastroenterology has published numerous articles that considered race, ethnicity, sex, and gender. 10,[21][22][23][24][25][26][27][28][29][30][31][32] The Journal is assessing approaches to the evaluation of original articles that promote fairness and inclusivity of people of color and both sexes in clinical and basic science research.…”

Section: Promote Equity Researchmentioning

confidence: 99%