Inferior Survival Is Associated With Socioeconomic Deprivation in Hepatocellular Carcinoma

Ruffolo, Luis I.; Zambrano, Dennis; Dale, Benjamin S.; Nimmagadda, Sai; Hack, Madelaine; Gaba, Harshita; Belt, Brian A.; Burchard, Paul R.; LanzDuret-Hernandez, Julia M.; Dokus, M. Katherine; Aponte, Jean Padilla; Tomiyama, Koji; Nair, Amit; Pineda-Solís, Karen; Hernandez‐Alejandro, Roberto

doi:10.1016/j.jss.2022.05.035

Cited by 10 publications

(4 citation statements)

References 45 publications

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“…As displayed in the findings, comorbidity burden is significantly associated with ADI and might represent underlying risk factors that affect donation or transplantation, and which are considered in clinical care but not accounted for in current metrics. ADI and similar indices have been shown in numerous studies to affect processes of care and patient outcomes Of note, ADI does not include race and ethnicity in the calculation, and while there is an association of minoritized race and ethnicity and residence in higher deprivation community, race and ethnicity are not factors in the current analysis. Thus, while ADI may represent multiple sources of risk related to disease burden, health care resources and access to health care, it is a robust indicator of variations in health and socioeconomic status.…”

Section: Discussionmentioning

confidence: 99%

Population Characteristics and Organ Procurement Organization Performance Metrics

Lopez,

Mohan,

Schold

2023

JAMA Netw Open

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ImportanceIn 2020, the Centers for Medicare &amp; Medicaid Services (CMS) issued a final rule updating the Organ Procurement Organization (OPO) Conditions for Coverage. This rule evaluates OPO performance based on an unadjusted donation rate and an age-adjusted transplant rate; however, neither considers other underlying population differences.ObjectiveTo evaluate whether adjusting for age and/or area deprivation index yields the same tier assignments as the cause, age, and location consistent (CALC) tier used by CMS.Design, Setting, and ParticipantsThis retrospective cross-sectional study examined the performance of 58 OPOs from 2018 to 2020 across the entire US. A total of 12 041 778 death records were examined from the 2017 to 2020 National Center for Health Statistics’ Restricted Vital Statistics Detailed Multiple Cause of Death files; 399 530 of these met the definition of potential deceased donor. Information about 42 572 solid organ donors from the Scientific Registry of Transplant Recipients was also used. Statistical analysis was performed from January 2017 to December 2020.ExposureArea deprivation of donation service areas and age of potential donors.Main Outcome and MeasuresOPO performance as measured by donation and transplant rates.ResultsA total of 399 530 potential deceased donors and 42 572 actual solid donor organs were assigned to 1 of 58 OPOs. Age and ADI adjustment resulted in 19.0% (11 of 58) to 31.0% (18 of 58) reclassification of tier ratings for the OPOs, with 46.6% of OPOs (27 of 58) changing tier ranking at least once during the 3-year period. Between 6.9% (4 of 58) and 12.1% (7 of 58) moved into tier 1 and up to 8.6% (5 of 58) moved into tier 3.Conclusions and RelevanceThis cross-sectional study of population characteristics and OPO performance metrics found that adjusting for area deprivation and age significantly changed OPO measured performance and tier classifications. These findings suggest that underlying population characteristics may alter processes of care and characterize donation and transplant rates independent of OPO performance. Risk adjustment accounting for population characteristics warrants consideration in prospective policy and further evaluation of quality metrics.

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Section: Discussionmentioning

confidence: 99%

Population Characteristics and Organ Procurement Organization Performance Metrics

Lopez,

Mohan,

Schold

2023

JAMA Netw Open

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“…A third‐party system used by the hospital was used to map patient addresses to Census block groups. We performed categorization of ADI for analysis as typically done in prior literature 7,26,27 by dichotomizing at the median ADI for our sample (ADI: 33 percentile). Not every address was able to be assigned to an ADI because ADI is not calculated when: (1) block group had low population or housing, or (2) block group had high group living, or (3) block group did not have an ADI due to missing variables from the American Community Survey 22 .…”

Section: Methodsmentioning

confidence: 99%

“…A third-party system used by the hospital was used to map patient addresses to Census block groups. We performed categorization of ADI for analysis as typically done in prior literature 7,26,27 by dichotomizing at the median ADI for our sample (ADI: 33 percentile).…”

Section: Neighborhood Socioeconomic Statusmentioning

confidence: 99%

Critical interactions between race and the highly granular area deprivation index in liver transplant evaluation

Strauss

Moughames

Jackson

et al. 2023

Clinical Transplantation

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Neighborhood socioeconomic deprivation may have important implications on disparities in liver transplant (LT) evaluation. In this retrospective cohort study, we constructed a novel dataset by linking individual patient‐level data with the highly granular Area Deprivation Index (ADI), which is advantageous over other neighborhood measures due to: specificity of Census Block‐Group (versus Census Tract, Zip code), scoring, and robust variables. Our cohort included 1377 adults referred to our center for LT evaluation 8/1/2016‐12/31/2019. Using modified Poisson regression, we tested for effect measure modification of the association between neighborhood socioeconomic status (nSES) and LT evaluation outcomes (listing, initiating evaluation, and death) by race and ethnicity. Compared to patients with high nSES, those with low nSES were at higher risk of not being listed (aRR = 1.14; 95%CI 1.05–1.22; p < .001), of not initiating evaluation post‐referral (aRR = 1.20; 95%CI 1.01–1.42; p = .03) and of dying without initiating evaluation (aRR = 1.55; 95%CI 1.09–2.2; p = .01). While White patients with low nSES had similar rates of listing compared to White patients with high nSES (aRR = 1.06; 95%CI .96–1.17; p = .25), Underrepresented patients from neighborhoods with low nSES incurred 31% higher risk of not being listed compared to Underrepresented patients from neighborhoods with high nSES (aRR = 1.31; 95%CI 1.12–1.5; p < .001). Interventions addressing neighborhood deprivation may not only benefit patients with low nSES but may address racial and ethnic inequities.

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“…While socially disadvantaged patients with HCC show inferior survivals ( 44 ), a group of French investigators failed to show any impact of SED on the post-transplant outcome of patients with HCC ( 35 ). In their registry analysis of 3,865 recipients, the European deprivation index (EDI) did not impact overall survival after LT for HCC, while the number of tumor nodules and time on the waiting list were the independent prognostic factors predicting survival ( 35 ).…”

Section: Adult Populationsmentioning

confidence: 99%

The impact of socioeconomic deprivation on liver transplantation

De Simone,

Germani,

Lai

et al. 2024

Front. Transplant.

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Despite global expansion, social disparities impact all phases of liver transplantation, from patient referral to post-transplant care. In pediatric populations, socioeconomic deprivation is associated with delayed referral, higher waitlist mortality, and reduced access to living donor transplantation. Children from socially deprived communities are twice as much less adherent to immunosuppression and have up to a 32% increased incidence of graft failure. Similarly, adult patients from deprived areas and racial minorities have a higher risk of not initiating the transplant evaluation, lower rates of waitlisting, and a 6% higher risk of not being transplanted. Social deprivation is racially segregated, and Black recipients have an increased risk of post-transplant mortality by up to 21%. The mechanisms linking social deprivation to inferior outcomes are not entirely elucidated, and powered studies are still lacking. We offer a review of the most recent evidence linking social deprivation and post-liver transplant outcomes in pediatric and adult populations, as well as a literature-derived theoretical background model for future research on this topic.

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Inferior Survival Is Associated With Socioeconomic Deprivation in Hepatocellular Carcinoma

Cited by 10 publications

References 45 publications

Population Characteristics and Organ Procurement Organization Performance Metrics

Population Characteristics and Organ Procurement Organization Performance Metrics

Critical interactions between race and the highly granular area deprivation index in liver transplant evaluation

The impact of socioeconomic deprivation on liver transplantation

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