Assessment of factors influencing health disparities in liver transplantation
Posters examine the impact of a patient’s ward on access to the liver transplant wait list and how the expansion of Medicaid has improved waitlist mortality.
Disparities in liver transplantation have been well documented, but 2 new posters presented at the Liver Meeting, organized by the American Association for the Study of Liver Diseases, assessed the role of neighborhood-level factors and the expansion of Medicaid.
In the first poster, the researchers assessed the relationship between the patient’s quarter and the liver transplant assessment.1 In a retrospective, single-center cohort study, they linked data from electronic health records to the Area Deprivation Index (ADI), which ranks census block groups from least disadvantaged to most disadvantaged using 17 measures based on neighborhoods from the American Community Survey.
Adults referred to a transplant center for live transplantation were evaluated from August 1, 2016 to December 31, 2019. The median age of patients was 56 years old and 40.7% were female. Patients were stratified by ADI in 4 groups, and age and sex were similar in all ADI groups.
They found that the most disadvantaged ADI group had a significantly higher proportion of black patients (51%) compared to the least disadvantaged group (6.8%). The most disadvantaged group also had a higher proportion of liver disease due to hepatocellular carcinoma (17.6%) compared to the least disadvantaged group (9.9%) and viral etiology (19.6% versus 5.6%, respectively).
Only 32% of patients in the total cohort were listed, and the researchers noted that patient neighborhood plays an important role in getting on the waiting list.
“For the transplant community to address equity, we will need to further elucidate solutions with a tiered approach,” they concluded.
The second poster assessed the impact of the Medicaid expansion under the Affordable Care Act on liver transplant waitlist mortality, as well as the impact on transplant rate by race / ethnicity. and the model score for end-stage liver disease (MELD).2
The authors examined data for expansion and non-expansion states during the pre-expansion (2008-2013) and post-expansion (2014-2018) period using the UNOS database. STAR. They found that the expansion of Medicaid was associated with improvements in mortality on wait lists and resulted in an overall increase in Medicaid rates on wait lists for liver transplants. However, the expansion of Medicaid has not been associated with an increase in transplant rates.
In addition, the expansion of Medicaid has been associated with a decrease in transplant rate compared to the wait list in patients with low MELD score and an increase in transplant rate in patients with high MELD score. . The researchers also found that the expansion of Medicaid was increasing the number of Hispanic patients on the waiting list. Black patients were impacted according to the MELD score.
“Widespread public health insurance can improve mortality on waiting lists and impact the demographics of patients undergoing transplantation,” they concluded.
1. Strauss AT, Hamilton JPA, Levin S, et al. Health disparities in the evaluation of liver transplantation according to deprivation of the patient’s quarter. Presented at: The Liver Meeting; November 12-15, 2021; virtual. Poster 635.
s. Wahid N, Lee J, Schpero W et al. Expansion of Medicaid under the Affordable Care Act associated with improvements in mortality on wait lists for liver transplants and differential impacts on racial and ethnic disparities in transplant access . Presented at: The Liver Meeting; November 12-15, 2021; virtual. Poster 648.