Background: Though discussions of equity in liver transplantation remain focused primarily on relative availability of allografts as a measure of access, differences in disease burden and waitlisting rates could supersede donor factors both across and within Donor Service Area boundaries.

Methods: We studied estimates of end stage liver disease (ESLD) prevalence and morbidity across multiple datasets for the state of Georgia. County-level data on Georgia residents from 2002-2015 were compiled from the United States Census Bureau, the Centers for Disease Control and Prevention, the Georgia Department of Health, and the Scientific Registry of Transplant Recipients. Counties were aggregated into quartiles based on percentage of residents living in poverty and Community Health Score.

Results: Among Georgia residents, there were 11,645 deaths from ESLD over the study period, of which only 750 (6.4%) occurred on the waitlist. The overall ESLD mortality rate was 14.12 deaths per 100,000 person-years (95% CI 13.53-14.70), though this varied from 11.19 (95% CI 10.27-12.10) among the wealthiest counties to 14.65 (95% CI 11.60-17.71) in the poorest quartile. ESLD-related discharges rose by 20% across poverty quartiles (p < 0.001). Waitlisting for transplant showed an inverse correlation with county poverty, with double the rate of waitlisting in the least-poor vs. most-poor counties (3.85 vs. 1.95 waitlist additions per person years, p < 0.001).

Conclusions: Transplant-specific sources greatly underestimate liver disease prevalence and morbidity/mortality, with the most pronounced inaccuracy in poorer areas. Data inclusive of these factors should be used to assess and frame policies affecting liver transplantation.

CITATION INFORMATION: Lynch R., Ross K., Magliocca J., Goldberg D., Patzer R. Poverty, End Stage Liver Disease, and Transplantation in Georgia Am J Transplant. 2017;17 (suppl 3).

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