Social support and risk of mortality in cirrhosis: A cohort study

Askgaard, Gro; Madsen, Lone Galmstrup; Wowern, Natasja von; Winther-Jensen, Matilde; Lau, Cathrine Juel; Christensen, Anne Illemann; Crooks, Colin J; West, Joe; Jepsen, Peter

doi:10.1016/j.jhepr.2022.100600

Cited by 6 publications

(6 citation statements)

References 50 publications

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“…A recent study from Denmark found that 22% of 541 patients with cirrhosis reported low social support, loneliness (35%) and lived alone (48%), these being higher proportions than among 2157 matched comparators. 22 Compared to patients with medium or high social support, those with low social support had a 5.1 (95% confidence interval (CI) 2.6–8.0, p<0.001) point lower mental HRQoL score and an adjusted HR risk of mortality of 1.4 (95% CI 1.1–1.9, p=0.011). 22 In other chronic conditions (eg, hypertension, obesity, diabetes), an intervention to provide greater social support and address social determinants of health, led to reductions in hospital use and better perceived quality of care.…”

Section: Discussionmentioning

confidence: 95%

“… 22 Compared to patients with medium or high social support, those with low social support had a 5.1 (95% confidence interval (CI) 2.6–8.0, p<0.001) point lower mental HRQoL score and an adjusted HR risk of mortality of 1.4 (95% CI 1.1–1.9, p=0.011). 22 In other chronic conditions (eg, hypertension, obesity, diabetes), an intervention to provide greater social support and address social determinants of health, led to reductions in hospital use and better perceived quality of care. 23 Greater understanding by hepatologists, liver specialist nurses and other allied health professionals of the wide-ranging needs of patients and their families, besides their medical needs and treatments, may improve referral to and engagement with different specialties or support services.…”

Section: Discussionmentioning

confidence: 95%

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Low Prevalence of Use of Allied Health and Community Services for Patients with Cirrhosis in Australia: A Need for Greater Engagement

Powell¹,

Stuart²,

Finnigan³

et al. 2023

PPA

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Background Psychosocial, lifestyle and practical needs are not routinely attended to during outpatient hepatology management, and little is known about the type and effectiveness of support services accessed by patients with cirrhosis. We quantified the type and use of community and allied health services in patients with cirrhosis. Methods The study included 562 Australian adults with a diagnosis of cirrhosis. Health service use was assessed via questionnaire and via linkage to the Australian Medicare Benefits Schedule. Patient needs were assessed using the Supportive Needs Assessment tool for Cirrhosis (SNAC). Results Although most patients (85.9%) used at least one community/allied health service for support with their liver disease, many reported requiring additional help with psychosocial (67.4%), lifestyle (34.3%) or practical needs (21.9%) that were not met by available services, or patients did not access services. A multidisciplinary care plan or case conference (in the 12 months prior to recruitment) was accessed by 48% of patients, 56.2% reported the use of a general practitioner for support with cirrhosis, and a dietician was the allied health clinician most accessed by patients (45.9%). Despite the high prevalence of psychosocial needs, there was relatively limited use of mental health and social work services (14.1% of patients reported the use of a psychologist), confirmed by a low prevalence of use of mental health services (17.7%) in the linked data. Conclusion Patients with cirrhosis who have unmet complex physical and psychosocial needs require better strategies to increase their engagement with allied health and community services.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Low Prevalence of Use of Allied Health and Community Services for Patients with Cirrhosis in Australia: A Need for Greater Engagement

Powell¹,

Stuart²,

Finnigan³

et al. 2023

PPA

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“…As for the inequality in mortality after ALD diagnosis, patients of lower socioeconomic position have lower levels of social support, which is an important factor for the ability to stay alcohol abstinent and have compliance with medical care ( 35 ). In England, the number of people entering alcohol addiction treatment has fallen during the study period ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Population-Based Study of Alcohol-Related Liver Disease in England in 2001–2018: Influence of Socioeconomic Position

Askgaard,

Jepsen,

Jensen

et al. 2024

Am J Gastroenterol

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Background: England has seen an increase in deaths due to alcohol-related liver disease (ALD) since 2001. We studied the influence of socioeconomic position on the incidence of ALD and the mortality after ALD diagnosis in England 2001–2018. Methods: This was an observational cohort study based on health records contained within the UK Clinical Practice Research Datalink covering primary care, secondary care, cause of death registration, and deprivation of neighbourhood areas in 18.8 million residents. We estimated incidence rate and incidence rate ratios (IRR) of ALD and hazard ratios (HR) of mortality. Findings: ALD was diagnosed in 57,784 individuals with a median age of 54 years and of whom 43% had cirrhosis. The ALD incidence rate increased by 65% between 2001 and 2018 in England to reach 56.1 per 100,000 person-years in 2018. The ALD incidence was threefold higher in those from the most vs. the least deprived quintile [IRR of 3.30 (95%: 3.21-3.38)], with reducing inequality at older than at younger ages. For 55–74-year-olds, there was a notable increase in the incidence rate between 2001 and 2018, from 96.1 to 158 per 100,000 person-years in the most and from 32.5 to 70.0 in the least deprived quintile. After ALD diagnosis, the mortality risk was higher for patients from the most vs. the least deprived quintile [HR of 1.22 (95%CI: 1.18-1.27)] and this ratio did not change during 2001-2018. Interpretation: The increasing ALD incidence in England is a greater burden on individuals of low compared to high socioeconomic position. This finding highlights ALD as a contributor to inequality in health.

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“…People living with fatty liver disease have unique support needs. A cohort study from 2023 demonstrated that low social support and loneliness (functional measures of social relationships) increased mortality risk in cirrhotic patients compared with noncirrhotic individuals 45 . Addressing these barriers will be a major challenge, not least given the prevalence of the disease; however, with this comes the opportunity to innovate and transform fatty liver disease models of care.…”

Section: Discussionmentioning

confidence: 99%

“…A cohort study from 2023 demonstrated that low social support and loneliness (functional measures of social relationships) increased mortality risk in cirrhotic patients compared with noncirrhotic individuals. [45] Addressing these barriers will be a major challenge, not least given the prevalence of the disease; however, with this comes the opportunity to innovate and transform fatty liver disease models of care. There is a wealth of experience that can be drawn on both within [37] and outside of the liver health community to inform this work, [46] including the World Health Organization frameworks on meaningful engagement of people living with NCDs [27] and people-centered health care.…”

Section: Domain 5: Patient and Community Perspectivesmentioning

confidence: 99%

A global action agenda for turning the tide on fatty liver disease

et al. 2023

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Background & Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach & Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over two rounds a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. Priorities were revised between rounds and in R2 panelists also ranked the priorities within six domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2 the mean percentage of ‘agree’ responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% ‘agree’). The highest ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reducing fatty liver disease prevalence and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.

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Social support and risk of mortality in cirrhosis: A cohort study

Cited by 6 publications

References 50 publications

Low Prevalence of Use of Allied Health and Community Services for Patients with Cirrhosis in Australia: A Need for Greater Engagement

Low Prevalence of Use of Allied Health and Community Services for Patients with Cirrhosis in Australia: A Need for Greater Engagement

Population-Based Study of Alcohol-Related Liver Disease in England in 2001–2018: Influence of Socioeconomic Position

A global action agenda for turning the tide on fatty liver disease

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