你住在哪里很重要:地区贫困预测生存率低,肝移植等待名单
Bima J Hasjim1, Alexander A Huang1, Mitchell Paukner2
1Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Northwestern University, Chicago, Illinois, USA.
概括
健康的社会决定因素 (SDOH) 显著影响肝硬化患者. 糟糕的邻里条件增加了脱补偿和死亡率,同时减少了肝移植 (LT) 等候名单的机会.
科学领域:
- 肝病学和移植外科手术
- 公共卫生和流行病学
- 社会科学和健康不平等的差异
背景情况:
- 健康的社会决定因素 (SDOH) 是慢性疾病结果的关键预测因素.
- 关于SDOH对肝硬化患者和肝移植 (LT) 患者的影响的研究有限.
研究的目的:
- 研究邻里级SDOH与肝硬化患者临床结果之间的关联.
- 检查SDOH对脱补偿,死亡率和LT等候名单的影响.
主要方法:
- 对芝加哥15101名成年肝硬化患者进行了回顾性,多机构的分析.
- 利用面积剥夺指数和美国人口普查调查数据来评估SDOH.
- 使用分发危险比率 (sHR) 来分析结果.
主要成果:
- 增加面积剥夺与更高的脱补偿率 (sHR 1.07) 和死亡率 (sHR 1.09) 有关.
- 更高的地区贫困与LT等候名单的可能性较低有关 (sHR 0.72).
- 低收入,教育,不良住房和社会支持与生存率降低和等待列表相关.
结论:
- 贫困社区的肝硬化患者面临更糟糕的结果,包括增加失补偿,死亡率和减少LT访问.
- 对LT和健康优化策略的结构性障碍需要进一步调查.
- 解决社区级SDOH对于改善肝硬化患者的护理至关重要.
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