A0484 - Liver Transplant Outcomes and Health Care Utilization Resources in African Americans: Are They Equitable?

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ahmed Ouni, MD

Mayo Clinic
Jacksonville, FL

Ahmed Ouni, MD, Pedro Palacios Argueta, MD, Kristen Ryland, ARNP, RD, Denise M. Harnois, DO
Mayo Clinic, Jacksonville, FL

Introduction: Liver transplantation continues to increase in the United States, and end-stage liver disease in African Americans (AA) has been shown to be associated with higher morbidity and mortality. However, there are scant studies on in-hospital outcomes and hospital healthcare utilization for AA patients who have undergone liver transplant (LT).

Methods: Retrospective review of the Nationwide Inpatient Sample (NIS) database using ICD10CM/PCS codes. A cross-sectional analysis was performed of patients aged 18 years and above that underwent liver transplant in 2018. Univariable logistic regression analysis was used to calculate unadjusted odds ratios (ORs) for the primary and secondary outcomes. Multivariable logistic regression analysis was used to adjust for potential confounders.

Results: A total of 7,290 LTs were performed in 2018; of these, 615 (8.4%) were performed in AA patients. AA patients compared to other races are more likely to be in the lowest quartile of income (40.1% vs 23.2%, P< 0.01), have Medicaid as primary payer (20.0% vs. 14.8%, P=0.04), to be from the South (56.1% vs 39.8%, P< 0.01) or Northeast (20.3% vs 17.3%, P< 0.01) region of the country. On univariate analysis, AA patients do not have increased length of stay (LOS) [OR 2.98; 95%CI (-1.05-7.02)], total charges [OR -18,285; 95%CI (-113,299-76,727)] and total costs [OR 12,128; 95%CI (-9,094-33,350)]. After adjusting for patient and hospital-level confounders, AA patients do not have significantly increased adjusted odds of mortality (aOR 0.48; P=0.59), length of stay (aOR 1.47days; P=0.57), total charges (aOR $-46,196; P= 0.26) or total costs (aOR $6,342; P=0.61).

Discussion: In 2018, this nationwide retrospective study does not show significantly higher odds of mortality or healthcare utilization resources in AA patients.

General Characteristics
	Total	White	African American		Hispanic	Asian	Native American		Other	P
No. (%) of patients	7290	4775	615		1065	270	65		220	0.03
Female, (%)	36	35	50		33	37	46		32	0.03
Mean age, years	55.3	56	52		55.0	57.5	56.2		53.2	0.10
Elective admission (%)	19.2	20.4	16.5		17.8	14.8	15.4		13.6	.60
Charlson Comorbidity index score, no. (%)
≥3	94.0	94.8	90.2		92.5	92.6	100		95.5	.11
Median annual income in patient’s zip code, US$ (%)
1-42,999	23.2	19.3	40.1	35.1		9.2	36.3		14.6	< .01
43,000-53,999	25.8	26.6	22.3	23.1		31.4	36.3		19.5	< .01
54,000-70,999	27.1	29.1	17.21	25.0		20.4	9.1		31.7	< .01
>71,000	23.9	24.9	18.8	16.8		38.9	18.2		34.1	< .01
Insurance type, (%)
Medicare	34.7	34.5	39.1		34.5	28.0	41.6		34.9	0.01
Medicaid	14.8	11.6	20.0		20.5	34.0	16.6		16.2	.04
Private	53.0	40.8	43.6		38.0	41.7	48.9		40.0	.01
Self-pay	0.8	0.7	0		0.1	0	0		0	.67
Hospital Region (%)
Northeast	17.3	17.9	20.3		10.3	18.5	7.6		31.8	< .01
Midwest	21.9	25.9	14.6		9.8	20.3	0		22.7	.08
South	39.8	33.9	56.1		38.9	16.6	23.8		29.5	< .01
West	20.9	16.2	8.9		40.8	44.4	69.2		15.9	< .01
Hospital bed size (%)
Small	2.2	1.7	1.6		4.6	1.8	0		2.2	0.23
Medium	15.5	16.5	24.3		8.4	1.8	0		9.0	.08
Large	82.7	81.6	73.9		86.8	96.3	100		88.6	.31
Hospital location / teaching status (%)
Urban teaching	99.2	99.3	100		100	100		100	100	0.51
Mortality rate and mean values for secondary outcomes
Mortality rate (%)	2.2	2.8	2.4		2.3	3.7		15.4	2.2
Length of stay, d	20.2	20.1	20.9		21.5	18.9		15.1	23.9
Total charges, US$		591743	562748		765958	877081		518387	730274	0.09
Total costs, US$		143594	139471		167842	177460		132274	181499	< .01

Crude Odds Ratio and Adjusted Differences for Primary and Secondary Outcomes for Patients that Underwent LT Classified by Races.
Race	Mortality	LOS (Days)	Time to transplant (Days)	Total charges (US$)	Total costs (US$)
Crude Odds Ratio (95% Confidence Interval)
White	Reference
African American	0.41 (0.05-3.26)	2.98 (-1.05-7.02)	0.95 (-1.49-3.40)	-18,285(-113,299-76,727)	12,128 (-9094-33,350)
Hispanic	1.84 (0.84-4.02)	7.19 (2.27-12.12)	2.07 (0.11-4.02)	306,940 (128,279-485,602)	67,502 (22,361-112,642)
Asian	1.00	-0.86 (-5.38-3.66)	0.62 (-2.94-4.18)	91,986 (-48,261-232,235)	24,409 (-8,251-57,071)
Native American	3.79 (0.93-32.96)	2.02 (-12.53-16.67)	-0.37 (-6.30-5.57)	77038 (-203,265-357,342)	20,459 (-58,338-80,991)
Other	0.77 (0.09-5.33)	10.25 (1.92-18.59)	1.84 (-0.35-4.05)	185,296(-10,542-381,135)	43,111 (5,231-80,991)
Adjusted difference; P value
White	Reference
African American	0.48; 0.59	1.47; 0.57	0.50; 0.65	-46,196; 0.26	6,342; 0.61

Table: General characteristics and crude odds ratio & adjusted differences for primary and secondary outcomes for patients that underwent LT classified by races

Disclosures:

Ahmed Ouni indicated no relevant financial relationships.

Pedro Palacios Argueta indicated no relevant financial relationships.

Kristen Ryland indicated no relevant financial relationships.

Denise Harnois indicated no relevant financial relationships.

Ahmed Ouni, MD, Pedro Palacios Argueta, MD, Kristen Ryland, ARNP, RD, Denise M. Harnois, DO. A0484 - Liver Transplant Outcomes and Health Care Utilization Resources in African Americans: Are They Equitable?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.