The Effect of Hospital Characteristics on Racial/Ethnic Variation in Cirrhosis Mortality

Chakrabarti, Apurba; Osborne, Nicholas H.; Rangnekar, Amol S.; Mathur, Amit K.

doi:10.1007/s40615-016-0223-2

Cited by 12 publications

(20 citation statements)

References 26 publications

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“…Despite these limitations, consideration of local conditions has the potential to add substantially to risk assessment. The higher prevalence of comorbid conditions, reduced access to care, environmental exposures, and behavioral attitudes characterizing high‐risk counties likely modify the biological course of ESLD in ways that otherwise go unmeasured . While individual effects from minority race, low socioeconomic status, and rural or remote location may not rise to the level of clinical or statistical significance, community conditions representing the summation of these risks may identify individuals underserved by current practices.…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic Determinants of Waitlist and Posttransplant Survival Among End-Stage Liver Disease Patients

Ross

Patzer

Goldberg

et al. 2017

American Journal of Transplantation

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While regional organ availability dominates discussions of distribution policy, community-level disparities remain poorly understood. We studied micro-geographic determinants of survival risk and their distribution across Donor Service Areas (DSAs). Scientific Registry of Transplant Recipients records for all adults waitlisted for liver transplantation 2002-2014 were reviewed. The primary exposure variables were county-level sociodemographic risk, as measured by the Community Health Score (CHS), a previously-validated composite index local health conditions, and distance to listing transplant center. Among 114 347 patients, the median CHS was 19.4 (range: 0-40). Compared the lowest risk counties (CHS 1-10), highest-risk counties (CHS 31-40) had more black (14.6% vs. 5.4%), publicly insured (44.9% vs. 33.0), and remote candidates (34.0% vs. 15.1% living >100 miles away). Higher-CHS candidates had greater waitlist mortality in Cox multivariable (HR 1.16 for CHS 31-40, 95% CI 1.11-1.21) and competing risks analysis (sHR 1.07, 95% CI 0.99-1.14). Post-transplant survival was similar across CHS quartiles. Living >25 miles from the transplant center conferred excess mortality risk (sHR 1.08, 95% CI 1.03-1.12). Proposed distribution changes would disproportionately impact DSAs with more high-CHS or distant candidates. Low-income, rural and minority patients experience excess mortality while awaiting transplant, and risk disproportionately worse outcomes with reduced organ availability under current proposals.

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Section: Discussionmentioning

confidence: 99%

Sociodemographic Determinants of Waitlist and Posttransplant Survival Among End-Stage Liver Disease Patients

Ross

Patzer

Goldberg

et al. 2017

American Journal of Transplantation

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“…More recently, in a large analysis of patients with cirrhosis across 4 American safety-net hospitals, no racial differences in mortality and 30-day were found [14]. Similarly, a nationwide sample showed increased unadjusted odds of mortality among Blacks, which dissipated after adjustment for potential confounders [15]. Thus, the effect of race on cirrhosis health outcomes is not well established.…”

Section: Introductionmentioning

confidence: 99%

Racial disparities of Black Americans hospitalized for decompensated liver cirrhosis

et al. 2020

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Background: Racial disparities have been reported in liver transplantation and chronic hepatitis C treatment outcomes. Determining causes of these disparities is important given the racially diverse American population and the economic burden associated with chronic liver disease. Methods: A retrospective study was performed among 463 patients diagnosed with cirrhosis admitted from (January 1, 2013 to January 1, 2018) to a tertiary care academic medical center. Patients were identified based on the International Classification of Diseases (ICD-10) for cirrhosis or its complications. Demographic information, laboratory data, medical comorbidities, insurance and adherence to cirrhosis quality care indicators were recorded to determine their relationship to readmission rates and other healthcare outcomes. Results: A total of 463 individual patients with cirrhosis were identified including Whites (n = 241), Hispanics (n = 106), Blacks (n = 50), Asian and Pacific Islander Americans (API, n = 27) and Other (n = 39). A significantly higher proportion of Blacks had Medicaid insurance compared to Whites (40% versus 20%, p = 0.0002) and Blacks had lower median income than Whites ($45,710 versus $54,844, p = 0.01). All groups received high quality cirrhosis care. Regarding healthcare outcomes, Black patients had the highest mean total hospital admissions (6.1 ± 6.3, p = 0.01) and the highest mean number of 30-day re-admissions (2.1 ± 3.7, p = 0.05) compared to all other racial groups. Multivariable proportional odds regression analysis showed that race was a statistically significant predictor of 90day readmission (p = 0.03). Conclusions: Black Americans hospitalized for complications of cirrhosis may experience significant disparities in healthcare outcomes compared to Whites despite high quality cirrhosis care. Socioeconomic factors may contribute to these disparities.

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“…This, perhaps, helps indicate that different factors may be affecting the worse outcomes in blacks and the poor. One relevant study, however, regarding ethnic differences in cirrhosis mortality suggested that the issue was admittance to facilities with reduced resources 22…”

Section: Discussionmentioning

confidence: 99%

Superior Performance of Teaching and Transplant Hospitals in the Management of Hepatic Encephalopathy from 2007 to 2014

Bodek

Patel

Ahlawat

et al. 2018

Journal of Clinical and Translational Hepatology

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Background and Aims: Hepatic encephalopathy is a liver disease complication with significant mortality and costs. The aim of this study was to evaluate the relative performance of facilities based on their teaching status and transplant capability by correlating their connections to mortality, cost, and length of stay from 2007 to 2014.Methods: The Nationwide Inpatient Sample database was utilized to collect information on (USA) American patients admitted with a primary diagnosis of hepatic encephalopathy from 2007–2014. Hospitals were placed into one of four categories using their teaching and transplant status. Using regression analysis, mortality, length of stay and cost adjusted rate ratios were calculated.Results: The study revealed that teaching transplant centers had a mortality risk ratio of 0.783 (95% confidence interval (CI): 0.750–0.819, p < 0.001). Blacks had the highest mortality risk ratio, of 1.273 (95%CI: 1.217–1.331, p < 0.001). Furthermore, teaching transplant hospitals had a cost rate ratio of 1.226 (95%CI: 1.214–1.238, p < 0.001) and a length of stay rate ratio of 1.104 (95%CI: 1.093–1.115, p < 0.001).Conclusions: It appears that admission to transplant facilities for hepatic encephalopathy is associated with reduced mortality but increased costs and longer stay independent of transplantation. Moreover, factors impacting black mortality should also be examined more closely.

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The Effect of Hospital Characteristics on Racial/Ethnic Variation in Cirrhosis Mortality

Cited by 12 publications

References 26 publications

Sociodemographic Determinants of Waitlist and Posttransplant Survival Among End-Stage Liver Disease Patients

Sociodemographic Determinants of Waitlist and Posttransplant Survival Among End-Stage Liver Disease Patients

Racial disparities of Black Americans hospitalized for decompensated liver cirrhosis

Superior Performance of Teaching and Transplant Hospitals in the Management of Hepatic Encephalopathy from 2007 to 2014

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