Current status of disparity in liver disease

Sempokuya, Tomoki; Warner, Josh; Azawi, Muaataz; Nogimura, Akane

doi:10.4254/wjh.v14.i11.1940

Cited by 3 publications

(5 citation statements)

References 89 publications

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“…Despite its cross‐sectional design, this study and the previous body of literature in this field have important implications for potential interventions at the individual, provider, and policymaker levels. Health disparities in liver disease are prominent among underserved racial/ethnic and lower socioeconomic groups, particularly in subgroups with the lowest incomes and limited resources 14,15 . The strengths of this study include the utilisation of a large number of participants who represented the US general population and an opportunity to analyse the recently updated dataset during the COVID‐19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…This study reported age-stratified ticularly in subgroups with the lowest incomes and limited resources. 14,15 The strengths of this study include the utilisation of a large number of participants who represented the US general population and an opportunity to analyse the recently updated dataset during the COVID-19 pandemic. On the contrary, this study also presented the following limitations.…”

Section: Comparisons Of Outcomes Based On the Insurance Types Comorbi...mentioning

confidence: 99%

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Financial hardship and cost‐related nonadherence to medication in patients with liver disease in the United States

Kim,

Manikat,

Wijarnpreecha

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundEconomic hardship associated with chronic liver disease (CLD) may delay timely access to healthcare.AimTo estimate the national burden of financial hardship across the spectrum of CLD in the United States (US) during the coronavirus disease 2019 (COVID‐19) pandemic.MethodsA cross‐sectional analysis was performed using the 2020–2021 US National Health Interview Survey database. The questionnaire defined financial hardship from medical bills and cost‐related nonadherence to medications in patients with CLD. We used weighted survey analysis to obtain the national estimates.ResultsWhile 6.9% (95% confidence interval [CI]: 6.7%–7.2%) out of 60,689 US adults (weighted sample: 251 million) reported financial hardship and inability to pay medical bills; 10.6% (95% CI: 8.3%–13.4%), 18.2% (95% CI: 14.5%–22.6%), 22.6% (95% CI: 11.0%–41.0%) with hepatitis, CLD/cirrhosis, and liver cancer experienced an inability to pay their medical bills due to financial hardship, respectively. 19.8% (95% CI: 15.9%–24.5%) and 23.3% (95% CI: 12.5%–39.3%) with CLD/cirrhosis and liver cancer, respectively experienced cost‐related nonadherence to medications, compared to a tenth of US adults (10.7%, 95% CI: 10.3%–11.2%). CLD/cirrhosis demonstrated an independent association with financial hardship from medical bills and cost‐related nonadherence to medications. Overall, these disparities were more pronounced in individuals aged <65 years old. In addition, over 40% of individuals with CLD/cirrhosis reported difficulties accessing medical care during the COVID‐19 pandemic. CLD/cirrhosis showed an independent association with difficulties accessing medical care due to COVID‐19.ConclusionsFinancial hardship from medical bills and cost‐related nonadherence to medication can negatively impact individuals with CLD and need further evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Comparisons Of Outcomes Based On the Insurance Types Comorbi...mentioning

confidence: 99%

Financial hardship and cost‐related nonadherence to medication in patients with liver disease in the United States

Kim,

Manikat,

Wijarnpreecha

et al. 2024

Aliment Pharmacol Ther

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“…Hepatocellular carcinoma has a clear male predominance, but sex-specific differences remain not completely understood [29,30]. Females have a lower risk of developing HCC versus males with an approximate incidence rate ratio of 1:4 [31].…”

Section: Discussionmentioning

confidence: 99%

Machine‐Based Learning Hierarchical Cluster Analysis: Sex‐Based Differences in Prognosis Following Resection of Hepatocellular Carcinoma

Resende,

Tsilimigras,

Endo

et al. 2023

World j. surg.

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Background Patients with hepatocellular carcinoma (HCC) may have a heterogeneous presentation, as well as different long-term outcomes following surgical resection. We sought to use machine learning to cluster patients into different prognostic groups based on preoperative characteristics. Methods Patients who underwent curative-intent liver resection for HCC between 2000 and 2020 were identified from a large international multi-institutional database. A hierarchical cluster analysis was performed based on preoperative factors to characterize patterns of presentation and define disease-free survival (DFS). Results Among 966 with HCC, 3 distinct clusters were identified: Cluster 1 (n = 160, 16.5%), Cluster 2 (n = 537, 55.6%) and Cluster 3 (n = 269, 27.8%). Cluster 1 (n = 160, 16.5%) consisted of female patients (n = 160, 100%), low inflammation-based scores, intermediate tumor burden score (TBS) (median: 4.71) and high alpha-fetoprotein (AFP) levels (median 41.3 ng/mL); Cluster 2 consisted of male individuals (n = 537, 100%), mainly with a history of HBV infection (n = 429, 79.9%), low inflammation-based scores, intermediate AFP levels (median 26.0 ng/mL) and lower TBS (median 4.49); Cluster 3 was comprised of older patients (median age 68 years) predominantly male (n = 248, 92.2%) who had low incidence of HBV/HCV infection (7.1% and 8.2%, respectively), intermediate AFP levels (median 16.8 ng/mL), high inflammation-based scores and high TBS (median 6.58). Median DFS worsened incrementally among the three different clusters with Cluster 3 having the lowest DFS (Cluster 1: median not reached; Cluster 2: 34 months, 95% CI 23.0-48.0, Cluster 3: 19 months, 95% CI 15.0-29.0, p \ 0.05). Conclusion Cluster analysis classified HCC patients into three distinct prognostic groups. Cluster assignment predicted DFS following resection of HCC with the female cluster having the most favorable prognosis following HCC resection.Vivian Resende and Diamantis I. Tsilimigras have contributed equally as co-first authors.

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“…Liver transplant (LT) is a life-saving treatment for end-stage liver disease, but access to this limited resource is highly competitive. 1 After the implementation of the Milan criteria in 1996, LT was used as the best treatment option in selected patients with hepatocellular carcinoma (HCC) and cirrhosis. 2 For allocation of LT, the model of end-stage liver disease (MELD) score is used, a numerical value based on creatinine, international normalization ratio (INR), and bilirubin, ranging from 6 to 40.…”

Section: Introductionmentioning

confidence: 99%

“…Liver transplant (LT) is a life-saving treatment for end-stage liver disease, but access to this limited resource is highly competitive . After the implementation of the Milan criteria in 1996, LT was used as the best treatment option in selected patients with hepatocellular carcinoma (HCC) and cirrhosis .…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Candidates for Hepatocellular Carcinoma Liver Transplant After 6-Month Wait Policy Change

Saberi,

Gurakar,

Tamim

et al. 2023

JAMA Netw Open

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ImportanceRacial disparities in liver transplant (LT) for hepatocellular carcinoma (HCC) may be associated with unequal access to life-saving treatment.ObjectiveTo quantify racial disparities in LT for HCC and mortality after LT, adjusting for demographic, clinical, and socioeconomic factors.Design, Setting, and ParticipantsThis cohort study was a retrospective analysis of United Network Organ Sharing/Organ Procurement Transplant Network (OPTN) data from 2003 to 2021. Participants were adult patients with HCC on the LT waiting list and those who received LT. Data were analyzed from March 2022 to September 2023.ExposuresRace and time before and after the 2015 OPTN policy change.Main Outcomes and MeasuresProportion of LT from wait-listed candidates, the proportion of waiting list removals, and mortality after LT.ResultsAmong 12 031 patients wait-listed for LT with HCC (mean [SD] age, 60.8 [7.4] years; 9054 [75.3%] male; 7234 [60.1%] White, 2590 [21.5%] Latinx/o/a, and 1172 [9.7%] Black or African American), this study found that after the 2015 model of end-stage liver disease (MELD) exception policy changes for HCC (era 2), the overall proportion of LT for HCC across all races decreased while the proportion of dropouts on the LT waiting list remained steady compared with patients who did not have HCC. In Kaplan-Meier analysis, Asian patients demonstrated the lowest dropout rates in both era 1 and era 2 (1-year dropout, 16% and 17%, respectively; P &lt; .001). In contrast, Black or African American patients had the highest dropout rates in era 1 (1-year dropout, 24%), but comparable dropout rates (23%) with White patients (23%) and Latinx/o/a patients in era 2 (23%). In both eras, Asian patients had the highest survival after LT (5-year survival, 82% for era 1 and 86% for era 2), while Black or African American patients had the worst survival after LT (5-year survival, 71% for era 1 and 79% for era 2). In the multivariable analysis for HCC LT recipients, Black or African American race was associated with increased risk of mortality in both eras, compared with White race (HR for era 1, 1.17; 95% CI, 1.05-1.35; and HR for era 2, 1.31; 95% CI, 1.10-1.56).Conclusions and RelevanceThis cohort study of LT candidates in the US found that after the 2015 MELD exception policy change for HCC, the proportion of LT for HCC had decreased for all races. Black or African American patients had worse outcomes after LT than other races. Further research is needed to identify the underlying causes of this disparity and develop strategies to improve outcomes for HCC LT candidates.

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Current status of disparity in liver disease

Cited by 3 publications

References 89 publications

Financial hardship and cost‐related nonadherence to medication in patients with liver disease in the United States

Financial hardship and cost‐related nonadherence to medication in patients with liver disease in the United States

Machine‐Based Learning Hierarchical Cluster Analysis: Sex‐Based Differences in Prognosis Following Resection of Hepatocellular Carcinoma

Racial Disparities in Candidates for Hepatocellular Carcinoma Liver Transplant After 6-Month Wait Policy Change

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