肝移植中的公平:我们已经接近了吗?
Moronke Ogundolie1, Norine Chan, Lisa M McElroy
1Duke University School of Medicine, Durham, North Carolina, USA.
Current opinion in organ transplantation
|June 20, 2023
概括
肝移植 (LT) 的健康公平仍然是一个挑战. 最近的研究突出了影响差异的社区因素和中心特征,在接入和结果方面存在持续的不平等,特别是在黑人儿科患者身上.
科学领域:
- 肝移植 (LT) 的健康公平研究.
背景情况:
- 随着政策的发展,监测公平获取的趋势和肝移植 (LT) 的结果至关重要.
- 检查LT的所有阶段的不平等:转诊,评估,列表,等待列表和LT后的结果.
研究的目的:
- 审查过去两年来肝移植健康公平研究的最新进展和发现.
- 评估肝移植在转诊,评估,列表,等待名单和移植后阶段的不平等情况.
主要方法:
- 对最近在肝移植方面的健康公平研究进行分析.
- 对影响差异的社区层面因素进行地理空间分析.
- 对影响等候名单访问的中心特定特征的审查.
主要成果:
- 地理空间分析确定了推动LT差异的社区因素 (例如,贫困,城市化).
- 特定中心的特点有助于等待列表访问的差异.
- 修改末期肝病模型 (MELD) 的高度得分是必要的,以解决基于性别的差异.
- 黑人儿科患者面临更高的死亡率和更糟糕的移植后结果,特别是在过渡到成人护理后.
结论:
- 尽管在方法和政策方面取得了进展,但在LT等候名单访问,结果和移植后结果方面仍然存在重大不平等.
- 未来的研究应该扩大健康措施的社会决定因素,采用多中心设计,完善MELD得分,并调查黑人患者的LT后结果.
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