Racial and ethnic disparities in liver transplant access vary within and across transplant referral regions.

IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Arrey-Takor Ayuk-Arrey, Lauren Nephew, Juan Carlos Caicedo, Katherine Ross-Driscoll
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Abstract

Prior studies have demonstrated racial disparities in access to liver transplantation, but the determinants of these disparities remain poorly understood. We used geographic catchment areas for transplant centers (transplant referral regions, TRRs) to characterize transplant environment contributors to racial and ethnic disparities in liver transplant access. Data were obtained from the Scientific Registry for Transplant Recipients and the National Center for Health Statistics from 2015 to 2021. The primary outcome was the difference in the listing-to-end-stage liver disease death ratio between Black, Hispanic, and non-Hispanic White patients for each TRR. We accounted for demographics, socioeconomic status, health care access, organ availability, and transplant center competition using multivariable linear regression. We examined intra-TRR differences in waitlist composition using Levene's test of variance. Across the 66 included TRRs, Black patients had lower listing-to-end-stage liver disease death ratios than White patients in 80% of TRRs, while Hispanic patients had equal or higher listing-to-end-stage liver disease death ratios compared to White patients in 56% of TRRs. The majority of variation in racial disparities across TRRs remained unexplained by multivariable models. Disparities were attenuated after excluding patients with HCC-associated mortality. Among the 27 TRRs that contained more than one transplant center, variance across TRRs was statistically significant for Black and Hispanic waitlist composition. We observed substantial geographic variation in the magnitude of racial disparities in liver transplant access across the United States. Findings highlight the need for targeted health equity interventions in regions with high disparities and the development of disparity-sensitive access metrics for transplant centers.

肝移植可及性的种族和民族差异在移植转诊地区内部和不同地区有所不同。
先前的研究表明,在获得肝移植方面存在种族差异,但这些差异的决定因素仍然知之甚少。我们使用移植中心的地理集水区(移植转诊区,TRRs)来表征导致肝移植准入中种族和民族差异的移植环境。方法:数据来自2015年至2021年移植受者科学登记处(SRTR)和国家卫生统计中心(NCHS)。主要转归是黑人、西班牙裔和非西班牙裔白人患者在每次TRR中与esld死亡率(LDR)的差异。我们使用多变量线性回归分析了人口统计学、社会经济地位、医疗保健获取、器官可用性和移植中心竞争。我们使用Levene的方差检验来检验候选名单组成的内部trr差异。结果:在66例纳入的trr中,80%的黑人患者的ldr低于白人患者,而56%的西班牙裔患者的ldr与白人患者相同或更高。跨trr的种族差异的大多数变异仍然无法用多变量模型解释。在排除hcc相关死亡率的患者后,差异减弱。在包含一个以上移植中心的27个trr中,黑人和西班牙裔等待名单组成在trr之间的差异具有统计学意义。结论:我们观察到美国各地肝移植准入的种族差异程度存在显著的地理差异。研究结果强调,有必要在差异较大的地区采取有针对性的卫生公平干预措施,并为移植中心制定对差异敏感的准入指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Liver Transplantation
Liver Transplantation 医学-外科
CiteScore
7.40
自引率
6.50%
发文量
254
审稿时长
3-8 weeks
期刊介绍: Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD, Liver Transplantation delivers current, peer-reviewed articles on liver transplantation, liver surgery, and chronic liver disease — the information necessary to keep abreast of this evolving specialty.
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