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Multicenter Study
. 2024 May;24(5):803-817.
doi: 10.1016/j.ajt.2024.02.009. Epub 2024 Feb 10.

Where you live matters: Area deprivation predicts poor survival and liver transplant waitlisting

Bima J Hasjim  1 , Alexander A Huang  1 , Mitchell Paukner  2 , Praneet Polineni  1 , Alexandra Harris  3 , Mohsen Mohammadi  4 , Kiarri N Kershaw  5 , Therese Banea  1 , Lisa B VanWagner  6 , Lihui Zhao  2 , Sanjay Mehrotra  4 , Daniela P Ladner  7
Affiliations
Multicenter Study

Where you live matters: Area deprivation predicts poor survival and liver transplant waitlisting

Bima J Hasjim et al. Am J Transplant. 2024 May.

Abstract

Social determinants of health (SDOH) are important predictors of poor clinical outcomes in chronic diseases, but their associations among the general cirrhosis population and liver transplantation (LT) are limited. We conducted a retrospective, multiinstitutional analysis of adult (≥18-years-old) patients with cirrhosis in metropolitan Chicago to determine the associations of poor neighborhood-level SDOH on decompensation complications, mortality, and LT waitlisting. Area deprivation index and covariates extracted from the American Census Survey were aspects of SDOH that were investigated. Among 15 101 patients with cirrhosis, the mean age was 57.2 years; 6414 (42.5%) were women, 6589 (43.6%) were non-Hispanic White, 3652 (24.2%) were non-Hispanic Black, and 2662 (17.6%) were Hispanic. Each quintile increase in area deprivation was associated with poor outcomes in decompensation (sHR [subdistribution hazard ratio] 1.07; 95% CI 1.05-1.10; P < .001), waitlisting (sHR 0.72; 95% CI 0.67-0.76; P < .001), and all-cause mortality (sHR 1.09; 95% CI 1.06-1.12; P < .001). Domains of SDOH associated with a lower likelihood of waitlisting and survival included low income, low education, poor household conditions, and social support (P < .001). Overall, patients with cirrhosis residing in poor neighborhood-level SDOH had higher decompensation, and mortality, and were less likely to be waitlisted for LT. Further exploration of structural barriers toward LT or optimizing health outcomes is warranted.

Keywords: cirrhosis; community; neighborhood; social determinants of health; transplant; waitlist.

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Conflict of interest statement

Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation. Lisa VanWagner serves as an advisor for Numares, Novo-Nordisk, and Gerson Lehrman Group, receives grant support from W.L. Gore & Associates, and provides expert witness services outside the submitted work. The other authors of this manuscript have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flow diagram of inclusion and exclusion criteria.
Figure 2.
Figure 2.
Conceptual framework for the role of social determinants of health and how they may contribute to disparities in cirrhosis outcomes.,
Figure 3.
Figure 3.
Map of Illinois and the distribution of ZIP codes and Area Deprivation Index (ADI) quintiles.
Figure 4.
Figure 4.. Kaplan-Meier survival curve stratified by Area Deprivation Index (ADI) quintile.
Figure 4A.) Among ADI quintile categories, there was a difference in survival time between patients living in the 5th ADI quintile (most deprived) and those living in less deprived ADI quintiles (p = 0.0021). Patients with cirrhosis who live in the 5th ADI quintile had shorter survival times compared to patients who reside in areas with lower ADI. Figure 4B.) Among ADI quintile categories, there was a difference in time to decompensation (p<0.0001)
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