一种基于大型语言模型的方法来量化社会决定因素在肝移植决策中的影响
Emily Robitschek1,2,3, Asal Bastani1, Kathryn Horwath1
1University of California, San Francisco, California, USA.
NPJ digital medicine
|November 17, 2025
概括
健康的社会决定因素和心理社会因素显著降低了肝移植上市的概率. 解决社会支持和心理健康等障碍对于减少差距至关重要.
科学领域:
- 移植研究 移植研究
- 在健康方面存在差异.
- 医疗保健中的人工智能
背景情况:
- 肝移植获得的持续差异与心理社会风险因素和健康的社会决定因素 (SDOH) 有关.
- 了解这些非临床因素对患者护理轨迹的影响对于公平的医疗保健至关重要.
- 现有的方法可能无法充分捕捉移植评估中SDOH和心理社会因素的复杂相互作用.
研究的目的:
- 开发和应用一个大型语言模型 (LLM) 框架来提取和分析心理社会风险因素和影响肝移植获取的SDOH.
- 量化可修改障碍对不同人口群体肝移植上市概率的影响.
- 确定心理社会和SDOH因素对肝移植列表决策中的种族差异的贡献.
主要方法:
- 开发一种新的LLM框架,从患者数据系统地识别和分析心理社会风险因素和SDOH.
- 对提取的因素进行统计分析,以确定它们的流行率和与肝移植上市概率的相关性.
- 分解分析以评估心理社会/SDOH因素与临床因素对列入名单决策中的种族差异的贡献.
主要成果:
- 关键的可修改障碍包括社会支持差距 (35.4%,女性更高),最近的物质使用 (14.2-22.7%),以及心理健康挑战 (17.6%,在西班牙裔/拉丁裔人群中注意到治疗差距).
- 每个确定的因素都与上市概率下降5-14个百分点有关,这表明了显著的临床影响.
- 心理社会和SDOH因素共同解释了42.6%的亚洲患者在列表决策中的种族差异,超过了肝脏健康指标 (36.8%) 的解释力.
结论:
- 心理社会风险因素和SDOH是肝移植获取和上市概率差异的重要驱动因素.
- 建议有针对性的干预措施,重点关注护理人员的支持,物质使用管理,心理健康护理和患者教育.
- 开发的LLM框架提供了一个强大的工具,可以增强对患者情况的理解,并解决移植中的健康不平等问题.
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