BLACK PATIENTS FARE WORSE? RACIAL DISPARITY REMAINS IN MODERN ERA FOR PATIENTS NEEDING LIVER TRANSPLANTATION FROM ACUTE LIVER FAILURE, A NATIONAL INPATIENT SAMPLE STUDY (2016-2020)
Nielsen M. Gabriel*2, Christopher K. Chhoun1, Fanchen Zhou3, Neethi R. Dasu1, Yaser Khalid4, Kenneth D. Chavin2, Sunil S. Karhadkar2, Antonio Di Carlo2, Kwan N. Lau2
1Jefferson Health New Jersey, Stratford, NJ; 2Temple University Hospital, Philadelphia, PA; 3University of Pennsylvania Wharton School, Philadelphia, PA; 4Wright Center for Graduate Medical Education, Scranton, PA
Background:
Acute liver failure affects patients of every demographic. Etiology of liver failure varies and has a wide array of treatment options. Orthotopic liver transplantation (OLT) remains the treatment of choice for patients who fail medical management. We sought to identify if racial disparities affect the survival of patients with acute liver failure.
Methods:
The National Inpatient Sample (NIS) database (2016-2020) was analyzed to identify adult (age > 18 years) patients admitted with ICD-10 CM/PCS codes for acute liver failure and OLT respectively. Multivariate logistic regression analysis was used to estimate the odds ratios of in-hospital mortality. Multivariate linear regression was used to determine the average length of hospital stay (LOS) and average total hospitalization charges. Weighted analysis using Stata 17 MP was performed. Patient age, race, and gender were controlled during regression analyses.
Results:
A total of 668 (n=668) patients underwent OLT with diagnoses of acute liver failure between 2016-2020. Of these 81 (12.1%) were black. As demonstrated in Table 1, multivariate logistic regression analysis was performed. Black patients were found to have a higher mortality rate (OR 2.55, CI 1.18-5.51, p<0.05) when compared to white patients. There was no statistically significant difference in mortality for Hispanic, Asian and Pacific Islander, or Native American patients.
Asians and Pacific islanders were found to have a decreased average LOS (-8.98 days, CI -15.2 - -2.71, p<0.01) when compared to white patients. There was no statistically significant variation in LOS and total hospital charges among different races.
Conclusions:
Black patients have worse in-hospital mortality when undergo OLT secondary to acute liver failure, even in the modern era. Black patients have historically worse outcomes secondary to lower socioeconomic status and access to care. Despite improvement in critical care, fairer organ allocation policy and access to care, Black patients still have worse outcomes. Additional resources should be made available to rectify these findings.
Table 1. Multivariate analysis comparing mortality, length of stay, and total cost of hospitalization for Black, Hispanic, and Asian and Pacific Islanders undergoing orthotopic liver transplantation as compared to White patients. * p<0.05; ** p<0.01
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