Abstract：
BACKGROUND: Ascites, a severe complication of cirrhosis, significantly impacts patient morbidity and mortality especially in Black patients. Access to disease optimizing care has been proposed as a potential driver of this disparity. In this study, we evaluate TIPS utilization across racial and ethnic groups.
METHODS: We examined data from a 20% random sample of US Medicare enrollees with continuous Part D coverage. We required 180 days of continuous outpatient enrollment prior to cirrhosis diagnosis and all patients had ≥1 paracentesis within 180 days of their cirrhosis diagnosis. Time zero was the date of the first paracentesis. We assessed the likelihood of TIPS placement. Analyses were conducted to determine the independent associations between each outcome and race/ethnicity.
RESULTS: 5915 patients (average age 68.2, 64.4% male) were included in the analysis. 439 (7.4%) patients were identified as Black, 223 (3.8%) as Hispanic, and 4942 (83.6%) as white. When compared to white patients in a multivariable analysis, Black patients were less likely to receive a TIPS procedure (hazard ratio 0.4; 95% confidence interval (CI) 0.2-0.8) and had less days alive outside of the hospital (-100.5; 95% CI -189.4 - -11.6). There were no significant differences in transplant-free survival or number of paracenteses per year between ethnic and racial groups.
CONCLUSIONS: Black patients are less likely to receive a TIPS procedure when controlling for common patient- and disease-specific variables. Access to optimal specialized services may be a significant driver for disparities in outcomes of patients with cirrhosis between racial and ethnic groups.
METHODS: We examined data from a 20% random sample of US Medicare enrollees with continuous Part D coverage. We required 180 days of continuous outpatient enrollment prior to cirrhosis diagnosis and all patients had ≥1 paracentesis within 180 days of their cirrhosis diagnosis. Time zero was the date of the first paracentesis. We assessed the likelihood of TIPS placement. Analyses were conducted to determine the independent associations between each outcome and race/ethnicity.
RESULTS: 5915 patients (average age 68.2, 64.4% male) were included in the analysis. 439 (7.4%) patients were identified as Black, 223 (3.8%) as Hispanic, and 4942 (83.6%) as white. When compared to white patients in a multivariable analysis, Black patients were less likely to receive a TIPS procedure (hazard ratio 0.4; 95% confidence interval (CI) 0.2-0.8) and had less days alive outside of the hospital (-100.5; 95% CI -189.4 - -11.6). There were no significant differences in transplant-free survival or number of paracenteses per year between ethnic and racial groups.
CONCLUSIONS: Black patients are less likely to receive a TIPS procedure when controlling for common patient- and disease-specific variables. Access to optimal specialized services may be a significant driver for disparities in outcomes of patients with cirrhosis between racial and ethnic groups.
摘要：
背景：腹水，肝硬化的严重并发症,显着影响患者的发病率和死亡率，尤其是黑人患者。已提出获得疾病优化护理作为这种差异的潜在驱动因素。在这项研究中,我们评估跨种族和族裔群体的TIPS利用率。
方法：我们检查了连续D部分覆盖的20%美国医疗保险参保者的随机样本数据。我们需要在肝硬化诊断前连续门诊登记180天，所有患者在肝硬化诊断180天内有≥1次穿刺。时间零点是第一次穿刺的日期。我们评估了TIPS放置的可能性。进行分析以确定每个结果与种族/民族之间的独立关联。
结果：5915例患者（平均年龄68.2，64.4%为男性）纳入分析。439名（7.4%）患者被确定为黑人，223（3.8%）为西班牙裔，和4942（83.6％）为白色。在多变量分析中与白人患者相比，黑人患者接受TIPS手术的可能性较小（风险比0.4;95％置信区间（CI）0.2-0.8），并且在医院外存活的天数较少（-100.5;95％CI-189.4--11.6）。种族和种族之间的无移植生存率或每年的平行数没有显着差异。
结论：Black患者在控制常见患者和疾病特异性变量时，接受TIPS程序的可能性较小。获得最佳的专业服务可能是种族和族裔之间肝硬化患者结果差异的重要驱动因素。
方法：我们检查了连续D部分覆盖的20%美国医疗保险参保者的随机样本数据。我们需要在肝硬化诊断前连续门诊登记180天，所有患者在肝硬化诊断180天内有≥1次穿刺。时间零点是第一次穿刺的日期。我们评估了TIPS放置的可能性。进行分析以确定每个结果与种族/民族之间的独立关联。
结果：5915例患者（平均年龄68.2，64.4%为男性）纳入分析。439名（7.4%）患者被确定为黑人，223（3.8%）为西班牙裔，和4942（83.6％）为白色。在多变量分析中与白人患者相比，黑人患者接受TIPS手术的可能性较小（风险比0.4;95％置信区间（CI）0.2-0.8），并且在医院外存活的天数较少（-100.5;95％CI-189.4--11.6）。种族和种族之间的无移植生存率或每年的平行数没有显着差异。
结论：Black患者在控制常见患者和疾病特异性变量时，接受TIPS程序的可能性较小。获得最佳的专业服务可能是种族和族裔之间肝硬化患者结果差异的重要驱动因素。
