Departments of Gastroenterology.
Internal Medicine, Rowan University Medical School, Stratford.
J Clin Gastroenterol. 2023 Mar 1;57(3):311-316. doi: 10.1097/MCG.0000000000001675.
Hepatocellular carcinoma (HCC) remains a deadly disease, with patients' best hope for a cure being liver transplantation; however, access to health care resources, such as donor organs, between ethnic groups has historically been unbalanced. Ensuring equitable access to donor livers is crucial to minimize disparities in HCC outcomes. As a result, we sought to better elucidate the differences in transplantation rates among various ethnic groups.
The National Inpatient Sample (NIS) was utilized to evaluate for disparities in liver transplantation in patients whose primary or secondary diagnosis was recorded as HCC or hepatoma. The study included admissions between 2007 and 2014 to centers with at least 1 documented liver transplant.
A total of 7244 transplants were performed over 70,406 weighted admissions. Black race was associated with lower transplantation rates, with an adjusted odds ratio of 0.46 (95% confidence interval: 0.42-0.51, P <0.01) when accounting for a number of possible confounders including socioeconomic and geographic factors.
Our study observed decreased rates of liver transplant in blacks compared with whites for HCC. Furthermore, improved economic status and private insurance had a significantly higher odds ratio for transplantation. Hospital-level studies are needed to clarify confounding factors not apparent in large administrative datasets and help better investigate factors that lead to less optimal transplant rates among blacks. Interventions may include more optimal screening policies and procedures, improved interdisciplinary management, and earlier referrals.
肝细胞癌（HCC）仍然是一种致命的疾病，患者治愈的最佳希望是肝移植；然而，历史上，不同种族之间的医疗保健资源（如供体器官）的获取并不平衡。确保公平获得供体肝脏对于最大限度地减少 HCC 结果的差异至关重要。因此，我们试图更好地阐明不同种族之间移植率的差异。
利用国家住院患者样本（NIS）评估 HCC 或肝癌的主要或次要诊断记录的患者的肝移植差异。该研究包括 2007 年至 2014 年期间在至少有 1 份记录的肝移植中心进行的住院治疗。
在 70406 次加权住院治疗中有 7244 例进行了移植。黑人种族与较低的移植率相关，在考虑到一些可能的混杂因素（包括社会经济和地理因素）后，调整后的优势比为 0.46（95%置信区间：0.42-0.51，P <0.01）。
我们的研究观察到与白人相比，黑人 HCC 的肝移植率较低。此外，经济状况改善和私人保险对移植的优势比更高。需要进行医院层面的研究，以阐明大型管理数据集不明显的混杂因素，并帮助更好地调查导致黑人移植率不理想的因素。干预措施可能包括更优化的筛选政策和程序、改善跨学科管理和更早的转诊。
