Hispanic Paradox in Patients with Liver Cirrhosis.
Northwestern University Transplant Research Collaborative, Chicago
Meeting: 2017 American Transplant Congress
Abstract number: 24
Keywords: Mortality, Multicenter studies, Multivariate analysis, Survival
Session Information
Session Name: Concurrent Session: Clinical Science: Liver - Hepatocellular Carcinoma
Session Type: Concurrent Session
Date: Sunday, April 30, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: E451b
Introduction
A paradoxical survival advantage for Hispanics compared to non-Hispanic whites (NHW) has been well described for many clinical conditions e.g diabetes however, with respect to liver disease worse outcomes for Hispanics have been reported. Previous data reporting worse outcomes is limited because comparisons are performed using the general population rather than populations with liver cirrhosis specifically. In the absence of a national database of patients with liver cirrhosis, we use a population based database (HealthLNK), to identify patients with liver cirrhosis and examine whether Hispanics with liver cirrhosis have better survival compared to other race/ethnicities.
Methods
HealthLNK aggregates EHR data from 5 academic and 1 county healthcare system in the Chicago metropolitan area. Patients with liver cirrhosis ICD-9(571.2,571.5,571.6) codes between Jan/06-Dec/12 were stratified by race/ethnicity. Analysis employed Cox proportional hazard models.
Results
Longitudinal data from 20,121 patients with cirrhosis were used:9150 (45%) were NHW, 4432 (22%) were African American (AA), 3279 (16%) were Hispanic, 529 (3%) were Asian and 2739 (14%) constituted other races. Median follow-up was 2.3 yrs. Overall, NHW (HR 1.3 CI 1.2-1.4) and AA (HR 1.2 CI 1.1-1.3) had an increased risk of death compared to Hispanics, while Asians had a reduced risk of death (HR 0.8CI 0.6-0.9). A survival advantage for Hispanics compared to NHW was observed for patients with alcoholic cirrhosis, HCV and HBV. Hispanic patients with HCC and NASH had no survival advantage compared to NHW
| HR(CI) Ref=Hispanics | |||
| NHW | AA | ASIAN | |
| All patients | 1.3(1.2-1.4) | 1.2(1.1-1.3) | 0.8(0.6-0.9) |
| HCC | 0.9 (0.8-1.1) | 1.02(0.8-1.2) | 0.5(0.4-0.8) |
| NASH | 1.2(0.9-1.4) | 1.1(0.9-1.4) | 0.9(0.6-1.7) |
| ALC | 1.5(1.3-1.7) | 1.5(1.3-1.7) | 0.7(0.4-1.2) |
| HCV | 1.3(1.1-1.4) | 1.2(1.03-1.4) | 0.6(0.4-0.9) |
| HBV | 1.6(1.1-2.3) | 1.4(0.9-1.9) | 1.1(0.7-1.6) |
Conclusion Contrary to previous reports of worse outcomes for Hispanics with liver disease, a survival benefit compared to NHW is observed for Hispanics although only for patients with alcoholic liver disease, HCV and HBV. For Hispanics, public health efforts should thus emphasize HCC and NASH were comparatively poorer outcomes are observed.
CITATION INFORMATION: Atiemo K, Caicedo J, Ganger D, Gordon E, Zhao L, Montag S, Maddur H, VanWagner L, Kulik L, Flamm S, Goel S, Kho A, Kang R, Abecassis M, Ladner D. Hispanic Paradox in Patients with Liver Cirrhosis. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Atiemo K, Caicedo J, Ganger D, Gordon E, Zhao L, Montag S, Maddur H, VanWagner L, Kulik L, Flamm S, Goel S, Kho A, Kang R, Abecassis M, Ladner D. Hispanic Paradox in Patients with Liver Cirrhosis. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/hispanic-paradox-in-patients-with-liver-cirrhosis/. Accessed November 24, 2024.« Back to 2017 American Transplant Congress