Disparities in Social Determinants of Health Among Patients Receiving Liver Transplant: Analysis of the National Inpatient Sample From 2016 to 2019

Abstract

BackgroundLiver transplantation is the life-saving standard of care for those with end-stage liver disease. Unfortunately, many patients on the liver transplant list die waiting. Several studies have demonstrated significant differences based on disparities in race, gender, and multiple socioeconomic factors. We sought to evaluate recent disparities among patients receiving liver transplants using the latest available data from the National Inpatient Sample (NIS), the largest publicly available inpatient care database in the United States. MethodsWe performed an analysis of discharge data from the NIS between 2016 and 2019. We identified adult patients with chronic liver disease who underwent a liver transplant using the International Classification of Diseases, 10th revision (ICD-10) codes. Multivariate logistic regression was used to adjust for differences in race, gender, socioeconomic status, and comorbidities among those who received a liver transplant. ResultsA total of 24,595 liver transplants were performed over the study period. Female gender was independently associated with decreased transplant rates (adjusted odds ratio (AOR) 0.83, 95% confidence interval (CI), 0.78-0.89, P < 0.001). Compared to White patients, Black patients had decreased transplant rates (AOR 0.86, 95% CI, 0.75-0.99, P = 0.034), as did Native Americans (AOR 0.64; 95% CI, 0.42-0.97, P = 0.035). Hispanics and Asian Americans had increased rates of liver transplantation (AOR 1.16, 95% CI 1.02-1.32, P = 0.022, and 1.36, 95% CI 1.11-1.67, P = 0.003; respectively). The increase in income quartile was associated with an incremental increase in transplant rates. Additionally, patients with private insurance had much higher transplant rates compared to those with Medicare (AOR 2.50, 95% CI 2.31-2.70, P < 0.001) while patients without insurance had the lowest rates of transplantation (AOR 0.18, 95% CI 0.12-0.28, P < 0.001). ConclusionsOur analysis demonstrates that race, gender, and other social determinants of health have significant impacts on the likelihood of receiving a liver transplant. Our study, on a national level, confirms previously described disparities in receiving liver transplantation. Patient-level studies are needed to better understand how these variables translate into differing liver transplantation rates.

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

“…Downstream interventions focus on individual behaviors and delivery improvements. 26 According to prior studies, social deprivation (ie, area-level 27 and neighborhood-level determinants 28 ), economic stability, 29 education attainment, 14 income, 30 sex, 31,32 insurance status (public vs private), and cost 33 are a few plausible factors that disadvantage patients on LT waiting lists and after LT. 34 Accordingly, there is a strong need for future…”

“…Downstream interventions focus on individual behaviors and delivery improvements . According to prior studies, social deprivation (ie, area-level and neighborhood-level determinants), economic stability, education attainment, income, sex, insurance status (public vs private), and cost are a few plausible factors that disadvantage patients on LT waiting lists and after LT . Accordingly, there is a strong need for future research to develop strategies to counter health inequities that contribute to limited access to care and address cultural and linguistic barriers that may prevent certain racial groups from accessing LT …”

The sex disparity in liver transplantation

“…Women are more likely to experience death on the waitlist or be removed from the waitlist for being “too sick.” Women are also less likely to get transplanted [4,6,11 ▪▪ ,12,13]. Furthermore, women only account for 36.1% of the liver transplant waitlist [12].…”