Publication Date
10-2-2024
Journal
BMJ Open Gastroenterology
DOI
10.1136/bmjgast-2024-001537
PMID
39357929
PMCID
PMC11448155
PubMedCentral® Posted Date
10-2-2024
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Humans, Carcinoma, Hepatocellular, Male, Female, Liver Neoplasms, Liver Transplantation, Middle Aged, Health Literacy, Prospective Studies, Social Determinants of Health, Aged, Risk Factors, Socioeconomic Factors, Adult, United States, Survival Analysis, liver transplantation, liver, hepatocellular carcinoma, economic evaluation
Abstract
OBJECTIVE: To investigate how individual social determinants of health (SDOH) and cumulative social disadvantage (CSD) affect survival and receipt of liver transplant (LT) in patients with hepatocellular carcinoma (HCC).
METHODS: We enrolled 139 adult patients from two Indianapolis hospital systems between June 2019 and April 2022. Structured questionnaires collected SDOH and social risk factor data. We compared SDOH and CSD by race, gender and disease aetiology, assigning one point per adverse SDOH. Multivariable competing risk survival analysis assessed associations between SDOH, CSD, survival and LT receipt.
RESULTS: Black patients experienced higher CSD than white patients in the cohort (5.4±2.5 vs 3.2±2.1, pCONCLUSIONS: There are significant racial and aetiology-related differences in SDOH burden. Low health literacy and high CSD are linked to worse outcomes in HCC patients. Health literacy screening and targeted interventions for those with high CSD could improve LT access and survival rates.
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