Neighborhood poverty is associated with failure to be waitlisted and death during liver transplantation evaluation.
Neighborhood poverty is associated with failure to be waitlisted and death during liver transplantation evaluation.
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DOI：
10.1002/lt.26473
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发表时间：
2022-09
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影响因子：
--
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中科院分区：
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--
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肝移植(LT)是复杂护理级联中的最后一步。鲜为人知的是，种族、性别、城乡或社区社会经济指标如何影响患者在接受肝移植评估期间等待肝移植的可能性或死亡风险。从2011年到2018年，我们对印第安纳大学学术医学中心转诊为LT的成年人进行了一项回顾性队列研究。社区社会经济状况指标是通过将患者的地址与2017年美国社区调查中定义的他们的人口普查地区联系起来获得的。描述性统计用于描述LT评价级联中各步骤的完成情况。多变量分析被用来评估在LT评估中与等待名单和死亡相关的因素。在研究期间，有3454名患者转诊为肝移植；25.3%的转诊患者等待接受肝移植。来自脆弱人群的患者进展到财务批准或评估开始阶段的比例没有差异。在等待名单上，不同的保险类型(医疗补助的22.6%与私人保险的34.3%；p <； 0.01)和社区贫困(四分位数1 29.6%vs.四分位数4 20.4%；p <； 0.01)。在多变量分析中，社区贫困与等待名单(优势比0.56，95%可信区间0.38-0.82)和在大肠移植评估中死亡(危险比1.49，95%可信区间1.09-2.09)独立相关。来自高贫困社区的患者面临无法被列入等待名单和在LT评估期间死亡的风险。
Liver transplantation (LT) is the final step in a complex care cascade. Little is known about how race, gender, rural versus urban residence, or neighborhood socioeconomic indicators impact a patient's likelihood of LT waitlisting or risk of death during LT evaluation. We performed a retrospective cohort study of adults referred for LT to the Indiana University Academic Medical Center from 2011 to 2018. Neighborhood socioeconomic status indicators were obtained by linking patients' addresses to their census tract defined in the 2017 American Community Survey. Descriptive statistics were used to describe completion of steps in the LT evaluation cascade. Multivariable analyses were performed to assess the factors associated with waitlisting and death during LT evaluation. There were 3454 patients referred for LT during the study period; 25.3% of those referred were waitlisted for LT. There was no difference seen in the proportion of patients from vulnerable populations who progressed to the steps of financial approval or evaluation start. There were differences in waitlisting by insurance type (22.6% of Medicaid vs. 34.3% of those who were privately insured; p < 0.01) and neighborhood poverty (quartile 1 29.6% vs. quartile 4 20.4%; p < 0.01). On multivariable analysis, neighborhood poverty was independently associated with waitlisting (odds ratio 0.56, 95% confidence interval [CI] 0.38–0.82) and death during LT evaluation (hazard ratio 1.49, 95% CI 1.09–2.09). Patients from high‐poverty neighborhoods are at risk of failing to be waitlisted and death during LT evaluation.
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影响因子：
2.1
作者：
Jesse, Michelle T.;Abouljoud, Marwan;Yoshida, Atsushi
通讯作者：
Yoshida, Atsushi
影响因子：
3.4
作者：
Butler, Danielle C.;Petterson, Stephen;Bazemore, Andrew W.
通讯作者：
Bazemore, Andrew W.
影响因子：
12.7
作者：
Singh, GK
通讯作者：
Singh, GK
影响因子：
8.8
作者：
Bryce, C. L.;Angus, D. C.;Roberts, M. S.
通讯作者：
Roberts, M. S.
DOI：
10.1177/1073110518766006
发表时间：
2018-03
期刊：
The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics
影响因子：
--
作者：
Gehlert S;Mozersky J
通讯作者：
Mozersky J