Disparities in End-Organ Care for Hispanic Patients with Kidney and Liver Disease: Implications for Access to Transplantation

Kutzler, Heather L.; Peters, Jonathon; O’Sullivan, David; Williamson, Anne E.; Cheema, Faiqa; Ebcioglu, Zeynep; Einstein, Michael; Rochon, Caroline; Ye, Xiaoyi; Sheiner, Patricia A.; Singh, Joseph; Sotil, Eva U.; Swales, Colin; Serrano, Oscar K.

doi:10.1007/s40137-020-00248-4

Cited by 2 publications

(2 citation statements)

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“…The reasons for this are likely multifactorial and reflect present disparities in differential rates of SARS-CoV-2 infection, 35,36 and longstanding disparities in access to treatment for liver diseases in the United States. [37][38][39] The broader questions regarding sex and racial/ethnic disparities during the COVID-19 pandemic are active areas of exploration among several N3C teams. [12][13][14] To further understand risk factors and patterns associated with adverse outcomes in SARS-CoV-2 infection, we conducted stratified analyses comparing mortality between cirrhosis/positive and cirrhosis/negative patients (Table 6).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study

et al. 2021

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Background and Aims In chronic liver disease (CLD) patients with or without cirrhosis, existing studies on the outcomes with SARS-CoV-2 infection have limited generalizability. We used the National COVID Cohort Collaborative (N3C), a harmonized electronic health record (EHR) dataset of 6.4 million, to describe SARS-CoV-2 outcomes in patients with CLD and cirrhosis. Methods We identified all CLD patients with or without cirrhosis who had SARS-CoV-2 testing in the N3C Data Enclave as of 7/1/2021. We used survival analyses to associate SARS-CoV-2 infection, presence of cirrhosis, and clinical factors with the primary outcome of 30-day mortality. Results We isolated 220,727 patients with CLD and SARS-CoV-2 test status: 128,864 (58%) Non-Cirrhosis/Negative, 29,446 (13%) Non-Cirrhosis/Positive, 53,476 (24%) Cirrhosis/Negative, and 8,941 (4%) Cirrhosis/Positive patients. Thirty-day all-cause mortality rates were 3.9% in Cirrhosis/Negative and 8.9% in Cirrhosis/Positive patients. Compared to Cirrhosis/Negative, Cirrhosis/Positive had 2.38-times adjusted hazard of death at 30 days. Compared to Non-Cirrhosis/Positive, Cirrhosis/Positive had 3.31-times adjusted hazard of death at 30 days. In stratified analyses among patients with cirrhosis with increased age, obesity, and comorbid conditions (diabetes, heart failure, and pulmonary disease); SARS-CoV-2 infection was associated with increased adjusted hazards of death. Conclusions In this study of ∼221,000 nationally-representative, diverse, and gender-balanced CLD patients; we found SARS-CoV-2 infection in patients with cirrhosis was associated with 2.38-times mortality hazard, and the presence of cirrhosis among CLD patients infected with SARS-CoV-2 was associated with 3.31-times mortality hazard. These results provide an additional impetus for increasing vaccination uptake and further research regarding immune responses to vaccines in patients with severe liver disease.

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Section: Discussionmentioning

confidence: 99%

Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study

et al. 2021

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“…In a recent nonrandomized, multi-site, hybrid trial, the implementation of a comprehensive culturally competent kidney transplant program, increased LDKT rates for Hispanic patients 60. Positive results from culturally competent interventions further reinforce that sociocultural factors influence LDKT disparities [61][62][63]. In addition to cultural differences among Hispanic individuals, heath-related behaviors or beliefs may be shaped by income, insurance status, knowledge of LDKT, geography, among other factors.…”

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confidence: 99%

Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: A systematic review

Alvarado

Cervantes

Crews

et al. 2022

American Journal of Transplantation

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We conducted a systematic review to assess outcomes in Hispanic donors and explore how Hispanic ethnicity was characterized. We searched PubMed, EMBASE, and Scopus through October 2021. Two reviewers independently screened study titles, abstracts, and full texts; they also qualitatively synthesized results and independently assessed quality of included studies. Eighteen studies met our inclusion criteria. Study sample sizes ranged from 4007 to 143,750 donors and mean age ranged from 37 to 54 years. Maximum follow-up time of studies varied from a perioperative donor nephrectomy period to 30 years post-donation. Hispanic donors ranged between 6% and 21% of the donor populations across studies. Most studies reported Hispanic ethnicity under race or a combined race and ethnicity category. Compared to non-Hispanic White donors, Hispanic donors were not at increased risk for post-donation mortality, end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, or overall perioperative surgical complications. Compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were seen regarding the risk for post-donation chronic kidney disease and hypertension. Future studies should evaluate cultural, socioeconomic, and geographic differences within the heterogeneous Hispanic donor population, which may further explain variation in health outcomes.

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Disparities in End-Organ Care for Hispanic Patients with Kidney and Liver Disease: Implications for Access to Transplantation

Cited by 2 publications

References 61 publications

Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study

Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study

Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: A systematic review

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