Pragmatic strategies to address health disparities along the continuum of care in chronic liver disease

Mayur Brahmania¹, Shari Rogal², Marina Serper³, Arpan Patel⁴, David Goldberg⁵, Amit Mathur⁶, Julius Wilder⁷, Jennifer Vittorio⁸, Andrew Yeoman⁹, Nicole E Rich¹⁰, Mariana Lazo¹¹, Ani Kardashian¹², Sumeet Asrani¹³, Ashley Spann¹⁴, Nneka Ufere¹⁵, Manisha Verma¹⁶, Elizabeth Verna¹⁷, Dinee Simpson¹⁸, Jesse D Schold¹⁹, Russell Rosenblatt¹⁷, Lisa McElroy²⁰, Sharad I Wadhwani²¹, Tzu-Hao Lee²², Alexandra T Strauss²³, Raymond T Chung¹⁵, Ignacio Aiza²⁴, Rotonya Carr²⁵, Jin Mo Yang²⁶, Carla Brady⁷, Brett E Fortune²⁷

Affiliations

¹ Department of Medicine, Division of Gastroenterology and Transplant Medicine, University of Calgary, Calgary, Alberta, Canada.
² Department of Medicine, Division of Gastroenterology, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
³ Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Medicine, Division of Gastroenterology, University of California Los Angeles, Los Angeles, California, USA.
⁵ Department of Medicine, Division of Gastroenterology, University of Miami, Miami, Florida, USA.
⁶ Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA.
⁷ Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA.
⁸ Department of Pediatrics, Division of Pediatric Gastroenterology, NYU Langone Health, New York, New York, USA.
⁹ Department of Medicine, Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, Wales, UK.
¹⁰ Department of Medicine, Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.
¹¹ Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹² Department of Medicine, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA.
¹³ Department of Medicine, Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA.
¹⁴ Department of Medicine, Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, USA.
¹⁵ Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁶ Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA.
¹⁷ Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA.
¹⁸ Department of Surgery, Northwestern University, Chicago, Illinois, USA.
¹⁹ Department of Surgery and Epidemiology, University of Colorado, Aurora, Colorado, USA.
²⁰ Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
²¹ Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
²² Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
²³ Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.
²⁴ Department of Medicine, Liver Unit, Hospital Ángeles Lomas, Mexico City, Mexico.
²⁵ Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA.
²⁶ Department of Medicine, Division of Gastroenterology, Catholic University of Korea, Seoul, Korea.
²⁷ Department of Medicine, Division of Hepatology, Montefiore Einstein Medical Center, Bronx, New York, USA.

PMID: 38696374
PMCID: PMC11068141
DOI: 10.1097/HC9.0000000000000413

Review

Pragmatic strategies to address health disparities along the continuum of care in chronic liver disease

Mayur Brahmania et al. Hepatol Commun. 2024.

. 2024 May 2;8(5):e0413.

doi: 10.1097/HC9.0000000000000413. eCollection 2024 May 1.

Authors

Affiliations

¹ Department of Medicine, Division of Gastroenterology and Transplant Medicine, University of Calgary, Calgary, Alberta, Canada.
² Department of Medicine, Division of Gastroenterology, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
³ Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Medicine, Division of Gastroenterology, University of California Los Angeles, Los Angeles, California, USA.
⁵ Department of Medicine, Division of Gastroenterology, University of Miami, Miami, Florida, USA.
⁶ Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA.
⁷ Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA.
⁸ Department of Pediatrics, Division of Pediatric Gastroenterology, NYU Langone Health, New York, New York, USA.
⁹ Department of Medicine, Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, Wales, UK.
¹⁰ Department of Medicine, Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.
¹¹ Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹² Department of Medicine, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA.
¹³ Department of Medicine, Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA.
¹⁴ Department of Medicine, Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, USA.
¹⁵ Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁶ Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA.
¹⁷ Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA.
¹⁸ Department of Surgery, Northwestern University, Chicago, Illinois, USA.
¹⁹ Department of Surgery and Epidemiology, University of Colorado, Aurora, Colorado, USA.
²⁰ Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
²¹ Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
²² Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
²³ Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.
²⁴ Department of Medicine, Liver Unit, Hospital Ángeles Lomas, Mexico City, Mexico.
²⁵ Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA.
²⁶ Department of Medicine, Division of Gastroenterology, Catholic University of Korea, Seoul, Korea.
²⁷ Department of Medicine, Division of Hepatology, Montefiore Einstein Medical Center, Bronx, New York, USA.

PMID: 38696374
PMCID: PMC11068141
DOI: 10.1097/HC9.0000000000000413

Abstract

Racial, ethnic, and socioeconomic disparities exist in the prevalence and natural history of chronic liver disease, access to care, and clinical outcomes. Solutions to improve health equity range widely, from digital health tools to policy changes. The current review outlines the disparities along the chronic liver disease health care continuum from screening and diagnosis to the management of cirrhosis and considerations of pre-liver and post-liver transplantation. Using a health equity research and implementation science framework, we offer pragmatic strategies to address barriers to implementing high-quality equitable care for patients with chronic liver disease.

PubMed Disclaimer

Conflict of interest statement

Marina Serper received grants from Grifols. Julius Wilder consults and received grants from Gilead and Janssen. He consults for Mallinckrodt, Intercept, Sanofi, and Allergan. He advises Health Monitor and owns stock in TRULab. Jennifer Vittorio advises and is on the speakers’ bureau for Mirum. Andrew Yeoman advises and is on the speakers’ bureau for Norgine. Ani Kardashian advises Gilead. Elizabeth Verna received grants from Sail. Rotonya Carr consults and received grants from Intercept. She received grants from Merck. The remaining authors have no conflicts to report.

Figures

**FIGURE 1**
Selected implementation strategies to address health care disparities in chronic liver disease.

**FIGURE 2**
Social-medical approach to addressing health care disparities in CLD.

See this image and copyright information in PMC

References

1. Asrani SK, Kouznetsova M, Ogola G, Taylor T, Masica A, Pope B, et al. . Increasing health care burden of chronic liver disease compared with other chronic diseases, 2004–2013. Gastroenterology. 2018;155:719–729.e4. - PubMed
1. Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999–2016: Observational study. BMJ (Online). 2018;362:k2817. - PMC - PubMed
1. WHO . Global health estimates 2015: Deaths by cause, age, sex, by country and by region, 2000–2015. Global Health Estimates Technical Paper. 2017 doi:10.1016/j.mpmed.2016.06.006 - DOI
1. Kwong A, Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, et al. . OPTN/SRTR 2018 annual data report: Liver. Am J Transplant. 2020;20(s1):193–299. - PubMed
1. Kardashian A, Serper M, Terrault N, Nephew LD. Health disparities in chronic liver disease. Hepatology. 2023;77:1382–1403. - PMC - PubMed

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Pragmatic strategies to address health disparities along the continuum of care in chronic liver disease

Affiliations

Pragmatic strategies to address health disparities along the continuum of care in chronic liver disease

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical