A large language model-based approach to quantifying the effects of social determinants in liver transplant decisions

Psychosocial risk factors and social determinants of health (SDOH) contribute to persistent disparities in liver transplantation access. We developed a large language model framework to extract and analyze how these factors influence care trajectories. Prevalence of key modifiable barriers varied by demographics: social support gaps (35.4%, disproportionately affecting females), recent substance use (14.2-22.7%), and mental health challenges (17.6%, with Hispanic/Latino treatment gaps). Each factor was associated with 5-14 percentage point reductions in listing probability, comparable to clinical metrics. Psychosocial risk and SDOH factors explained 42.6% of racial disparities in listing decisions for Asian patients, exceeding liver health metrics (36.8%) and contributing to 94.6% collective explanation of differences. Priority interventions should target caregiver support, substance use, mental health, and patient education. This framework for systematically analyzing patient circumstances could enhance understanding of care decisions and health disparities.