Racial disparities - patients with cirrhosis

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Hepatology. 2007 May;45(5):1282-9.

Racial disparities in the management

of hospitalized patients with cirrhosis and complications of portal

hypertension: a national study.

Nguyen GC, Segev DL, Thuluvath PJ.

Division of Gastroenterology, Department of Medicine, s

Hopkins University

Having complications of portal hypertension is a harbinger of decompensated

cirrhosis and warrants consideration for liver transplantation (LT). Racial disparities in LT have been reported. We sought to characterize disparities in the performing of

surgical and endoscopic procedures among hospitalized

patients with complications of portal hypertension. We

queried the Nationwide Inpatient Sample from 1998 to 2003 to identify patients

with cirrhosis and complications of portal hypertension. Logistic

regression controlling for confounders was used to evaluate race as a predictor

of undergoing a portosystemic shunt and LT and of

dying in the hospital. Compared to whites, the

adjusted odds ratios of receiving a portosystemic

shunt were 0.37 (95% CI: 0.27-0.51) and 0.69 (95% CI: 0.54-0.88) for African

Americans (AAs) and Hispanics, respectively. AAs with variceal

bleeding were more likely to have endoscopic variceal hemostasis delayed more

than 24 hours after admission than were whites (OR 1.6; 95% CI: 1.2-2.1). The adjusted odds ratios of undergoing LT were 0.32 (95%

CI:0.20-0.52) and 0.46 (95% CI: 0.25-0.83) for AAs

and Hispanics, respectively. Compared to whites, AAs experienced higher in-hospital mortality (OR 1.12; 95%

CI: 1.01-1.24), whereas Hispanics had a lower risk of death (OR 0.83; 95% CI:

0.75-0.92). Among variceal

bleeders, the odds ratio of death for AAs was 1.7

(95% CI: 1.2-2.4) compared to whites. CONCLUSION: AAs and Hispanics hospitalized for complications of portal

hypertension were less likely to undergo a palliative shunt or LT than whites,

which may contribute to the higher in-hospital mortality of AAs. Further studies are warranted to elucidate the mechanisms

of these exploratory findings.

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