Department of MedicineQueen's UniversityKingstonOntarioCanada.
Public Health SciencesQueen's UniversityKingstonOntarioCanada.
Hepatology. 2022 Oct;76(4):1079-1089. doi: 10.1002/hep.32469. Epub 2022 Apr 8.
This study evaluated the association between neighborhood-level social determinants of health (SDOH) and liver transplantation (LT) among patients with cirrhosis who have universal access to health care.
This was a retrospective population-based cohort study from 2000-2019 using administrative health care data from Ontario, Canada. Adults aged 18-70 years with newly decompensated cirrhosis and/or HCC were identified using validated coding. The associations between five neighborhood level SDOH quintiles and LT were assessed with multivariate Fine-Gray competing risks regression to generate subdistribution HRs (sHRs) where death competes with LT. Overall, n = 38,719 individuals formed the cohort (median age 57 years, 67% male), and n = 2788 (7%) received LT after a median of 23 months (interquartile range 3-68). Due to an interaction, results were stratified by sex. After multivariable regression and comparing those in the lowest versus highest quintiles, individuals living in the most materially resource-deprived areas (female sHR, 0.61; 95% CI, 0.49-0.76; male sHR, 0.55; 95% CI, 0.48-0.64), most residentially unstable neighborhoods (female sHR, 0.61; 95% CI, 0.49-0.75; male sHR, 0.56; 95% CI, 0.49-0.65), and lowest-income neighborhoods (female sHR, 0.57; 95% CI, 0.46-0.7; male sHR, 0.58; 95% CI, 0.50-0.67) had ~40% reduced subhazard for LT (p < 0.01 for all). No associations were found between neighborhoods with the most diverse immigrant or racial minority populations or age and labor force quintiles and LT.
This information highlights an urgent need to evaluate how SDOH influence rates of LT, with the overarching goal to develop strategies to overcome inequalities.
本研究评估了在普遍获得医疗保健的情况下，社区层面健康决定因素（SDOH）与肝硬化患者肝移植（LT）之间的关联。
这是一项回顾性基于人群的队列研究，使用来自加拿大安大略省的行政医疗保健数据，时间范围为 2000 年至 2019 年。通过验证后的编码，确定患有新失代偿性肝硬化和/或 HCC 的 18-70 岁成年人。使用多变量 Fine-Gray 竞争风险回归评估五个社区层面 SDOH 五分位数与 LT 之间的关联，以生成亚分布风险比（sHR），其中死亡与 LT 竞争。总体而言，38719 人组成了队列（中位数年龄为 57 岁，67%为男性），2788 人（7%）在中位数为 23 个月（四分位间距 3-68）后接受 LT。由于存在交互作用，结果按性别分层。经过多变量回归并比较最低五分位数与最高五分位数，生活在物质资源最匮乏地区的个体（女性 sHR，0.61；95%CI，0.49-0.76；男性 sHR，0.55；95%CI，0.48-0.64），居住最不稳定的社区（女性 sHR，0.61；95%CI，0.49-0.75；男性 sHR，0.56；95%CI，0.49-0.65）和收入最低的社区（女性 sHR，0.57；95%CI，0.46-0.7；男性 sHR，0.58；95%CI，0.50-0.67），LT 的亚危险度降低约 40%（所有 p<0.01）。在移民或少数族裔人口最多的社区与 LT 之间以及年龄和劳动力五分位数与 LT 之间未发现关联。
这些信息突显了迫切需要评估 SDOH 如何影响 LT 率，总体目标是制定克服不平等的策略。
