Association of Primary Care Shortage Areas with Adverse Outcomes after Pediatric Liver Transplant - 22/06/22
Abstract |
Objective |
To characterize associations between living in primary care shortage areas and graft failure/death for children after liver transplantation.
Study design |
This was an observational study of all pediatric patients (aged <19 years) who received a liver transplant between January 1, 2005, and December 31, 2015 in the US, with follow-up through January 2019 (N = 5964). One hundred ninety-five patients whose home ZIP code could not be matched to primary care shortage area status were excluded. The primary outcome was a composite endpoint of graft failure or death. We used Cox proportional hazards to model the associations between health professional shortage area (HPSA) and graft failure/death.
Results |
Children living in HPSAs had lower estimated graft survival rates at 10 years compared with those not in HPSAs (76% vs 80%; P < .001). In univariable analysis, residence in an HPSA was associated with a 22% higher hazard of graft failure/death than non-residence in an HPSA (hazard ratio [HR], 1.22; 95% CI, 1.09-1.36; P < .001). Black children from HPSAs had a 67% higher hazard of graft failure/death compared with those not in HPSAs (HR, 1.67; 95% CI, 1.29 to 2.16; P = .006); the effect of HPSA status was less pronounced for White children (HR, 1.11; 95% CI, 0.98-1.27; P = .10).
Conclusions |
Children living in primary care shortage areas are at increased risk of graft failure and death after liver transplant, and this risk is particularly salient for Black children. Future work to understand how living in these regions contributes to adverse outcomes may enable teams to mitigate this risk for all children with chronic illness.
Le texte complet de cet article est disponible en PDF.Keywords : liver transplant, primary care availability, pediatric chronic disease, structural racism
Abbreviations : %<FPL, HPSA, HR, HRSA, MELD, PCP, PELD, SRTR
Plan
| Supported in part by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)/NASPGHAN Foundation (H.S.), the National Institutes of Health (NIH) (Grant T32 DK 7727-24; PI Lee Denson, support for S.W.), the University of California San Francisco Liver Center (Grant P30 DK026743, to S.W., C-Y.H., and J.L.), and the National Center for Advancing Translational Sciences (Award KL2TR001870, to S.W.). The content is solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors declare no conflicts of interest. |
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| Portions of this study were presented as a poster presentation at the NASPGHAN virtual Annual Meeting on December 15, 2021 and also being presented as an oral presentation at the Pediatric Academic Societies (PAS) Meeting, April 23, 2022, Denver, Colorado. |
Vol 246
P. 103 - juillet 2022 Retour au numéro
Article précédent
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