Black Patients with Cirrhosis have Higher Mortality and Lower Transplant Rates: Results from a Metropolitan Cohort Study

Link to article at PubMed

Hepatology. 2021 Jun 15. doi: 10.1002/hep.31742. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Estimates of racial disparity in cirrhosis have been limited by lack of large scale, longitudinal data which track patients from diagnosis to death and/or transplant.

APPROACH & RESULTS: We analyzed a large metropolitan population-based electronic health record dataset from seven large health systems linked to the state death registry and the national transplant database. Multivariate competing risk analyses adjusted for gender, age, insurance status, Elixhauser score, etiology of cirrhosis, hepatocellular carcinoma (HCC), portal hypertensive complication, and Model for End Stage Liver Disease-Sodium (MELD-Na) examined the relationship between race, transplant, and cause of death as defined by blinded death certificate review. During the study period, 11,277 patients met inclusion criteria of whom 2,498 (22.2%) identified as Black. Compared to White patients, Black patients had similar age, sex, MELD-Na, and proportion of alcohol related liver disease but higher comorbidity burden, lower rates of private insurance, and lower rates of portal hypertensive complications. Compared to White patients, Black patients had the highest rate all-cause mortality and non-liver related death and were less likely to be listed or transplanted (p<0.001 for all). In multivariate competing risk analysis Black patients had a 26% increased hazard of liver-related death (sHR 1.26 95% CI[1.15-1.38], p<0.001).

CONCLUSIONS: Black patients with cirrhosis have discordant outcomes. Further research is needed to determine how to address these real disparities in the field of Hepatology.

PMID:34128254 | DOI:10.1002/hep.31742

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