Rubin Jessica B, Loeb Rebecca, Monto Alexander, Wong Robert J, Cheung Ramsey, Batki Steven L, Ostacher Michael J, Shen Hui, Hoggatt Katherine J, Satre Derek D, Khalili Mandana
Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California.
VA Medical Center, San Francisco Veterans Affairs Healthcare System, San Francisco, California.
Gastro Hep Adv. 2025 May 27;4(9):100711. doi: 10.1016/j.gastha.2025.100711. eCollection 2025.
The COVID-19 pandemic disrupted health-care delivery for chronic conditions managed in specialty care and particularly among socioeconomically disadvantaged and Veteran populations. Clinical outcomes in cirrhosis are highly dependent on routine care, including clinic visits, labs, and imaging. This study examines the pandemic's impact on adherence to cirrhosis-related quality indicators and clinical outcomes among Bay Area Veterans receiving hepatology care.
We conducted a retrospective cohort study of Veterans with cirrhosis seen at San Francisco and Palo Alto Veterans Affairs hepatology clinics (March 2017-March 2023). Adherence to quality indicators-hepatocellular carcinoma (HCC) screening, lab monitoring, and hepatology visits-was compared between prepandemic (2017-2020) and pandemic-postpandemic (2020-2023) periods. Multivariable logistic regression assessed the effect of time and pandemic phase on clinical outcomes, including new hepatic decompensation, new HCC, and liver-related hospitalizations or death.
Among 1501 Veterans with cirrhosis (median age 67 years, 97% male), adherence to quality indicators declined during the pandemic, with hepatology visits decreasing from 1.5/year to 1.0/year, and telehealth use increasing sevenfold. Overall mortality rates were higher during the pandemic (21% vs 17%) possibly related to nonliver causes, since on multivariable models, the pandemic phase was associated with lower odds of new decompensation (adjusted odds ratio (aOR) 0.87, 95% confidence interval (CI) 0.5-0.9, = .01) and HCC diagnosis (aOR 0.7, 95% CI 0.5-0.95, = .02); liver-related hospitalizations or death also declined over (aOR 0.98, 95% CI 0.97-0.99, < .001).
The pandemic significantly disrupted cirrhosis care among Bay Area Veterans, potentially resulting in "health debt" that may affect outcomes in coming years. Targeted interventions should re-engage patients, addressing these care gaps and improving clinical outcomes.
新冠疫情扰乱了专科护理中慢性病的医疗服务，在社会经济弱势群体和退伍军人中尤为如此。肝硬化的临床结局高度依赖常规护理，包括门诊就诊、实验室检查和影像学检查。本研究探讨了疫情对接受肝病护理的湾区退伍军人肝硬化相关质量指标依从性和临床结局的影响。
我们对在旧金山和帕洛阿尔托退伍军人事务部肝病诊所就诊的肝硬化退伍军人进行了一项回顾性队列研究（2017年3月至2023年3月）。比较了疫情前（2017 - 2020年）和疫情期间及之后（2020 - 2023年）对质量指标（肝细胞癌（HCC）筛查、实验室监测和肝病门诊就诊）的依从性。多变量逻辑回归评估了时间和疫情阶段对临床结局的影响，包括新的肝失代偿、新的HCC以及与肝脏相关的住院或死亡。
在1501名肝硬化退伍军人（中位年龄67岁，97%为男性）中，疫情期间对质量指标的依从性下降，肝病门诊就诊次数从每年1.5次降至每年1.0次，远程医疗的使用增加了7倍。疫情期间总体死亡率较高（21%对17%），可能与非肝脏原因有关，因为在多变量模型中，疫情阶段与新的失代偿（调整后的优势比（aOR）0.87，95%置信区间（CI）0.5 - 0.9，P = 0.01）和HCC诊断（aOR 0.7，95% CI 0.5 - 0.95，P = 0.02）的较低几率相关；与肝脏相关的住院或死亡也有所下降（aOR 0.98，95% CI 0.97 - 0.99，P < 0.001）。
疫情严重扰乱了湾区退伍军人的肝硬化护理，可能导致“健康债务”，这可能会影响未来几年的结局。有针对性的干预措施应重新吸引患者，填补这些护理缺口并改善临床结局。
