Multilevel determinants of racial disparities in outcomes among liver transplant recipients in the United States

美国肝移植受者结局种族差异的多层次决定因素

基本信息

批准号：
9911441
负责人：
Katie Ross-Driscoll
金额：
$ 4.24万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-02-17 至 2020-12-31
项目状态：
已结题

项目摘要

Project Summary Liver transplantation is the only curative treatment for end-stage liver disease (ESLD), which kills approximately 50,000 people in the United States each year. There are substantial and persistent racial disparities in liver transplant outcomes. Black patients have lower graft function, worse graft survival, and worse overall survival after liver transplantation than do patients of any other race. The association of race, survival, and shorter-term outcomes, such as hospital readmissions, remains unclear for liver transplant recipients. Hospital readmission may represent a potential target for intervention and a marker to identify groups at high risk for poor outcomes while they are accessible to clinicians. The overall goal of this project is to identify determinants of racial disparities in both short-term (hospitalization) and long-term (survival) outcomes among liver transplant recipients. Using national data from the Scientific Registry of Transplant Recipients (SRTR), a population-based registry of transplant recipients, I will conduct a retrospective cohort study of patients who received a liver transplant in the United States from 2003 to 2017. I will use hierarchical survival analysis to determine whether the association of race with post-transplant survival differs by characteristics of the transplant center. I will then use multivariable log-binomial regression to estimate the association between patient race and risk of hospital readmission within six months of transplant, and conduct a mediation analysis to determine whether racial disparities in survival after transplant are mediated through hospital readmission. The SRTR documents whether recipients are hospitalized in the six months following transplant. However, there is no information collected on the timing of hospitalization within that interval, reasons for hospitalization, or the overall burden of hospitalization; these characteristics provide important insight into the underlying mechanisms of hospitalization. I will use more granular data from the Emory Transplant Center, one of the largest transplant centers in the nation, to identify racial disparities in these novel outcomes. Upon completion of these aims, I will have identified characteristics of transplant centers suitable for intervention to reduce racial disparities in outcomes, quantified the potential impact of differences in hospital readmission on disparities in survival, and identified differences in hospitalization characteristics by race. Each of these objectives contributes to my long-term goal of informing future multilevel interventions to improve patient care and reduce inequity among liver transplant recipients.

项目概要肝移植是终末期肝病（ESLD）的唯一治疗方法，该病可导致死亡美国每年约有 50,000 人。存在大量且持久的种族问题肝移植结果的差异。黑人患者的移植物功能较低，移植物存活率较差，并且肝移植后的总体生存率比任何其他种族的患者都要差。种族协会，肝移植的生存率和短期结果（例如再入院）仍不清楚收件人。再入院可能是干预的潜在目标和识别标记临床医生可以接触到的高风险人群，但这些人群可能会出现不良结果。该项目的总体目标是确定短期（住院）种族差异的决定因素以及肝移植受者的长期（生存）结果。使用来自科学的国家数据移植受者登记处 (SRTR)，一个基于人群的移植受者登记处，我将进行一次对 2003 年至 2017 年在美国接受肝移植的患者进行的回顾性队列研究。 I 将使用分层生存分析来确定种族与移植后生存是否存在关联根据移植中心的特点而有所不同。然后我将使用多变量对数二项式回归估计移植后六个月内患者种族与再入院风险之间的关联，并进行中介分析以确定移植后生存率的种族差异是否通过重新入院进行调解。 SRTR 记录受者在移植后六个月内是否住院。然而，没有收集有关该时间间隔内住院时间、住院原因的信息，或住院的总体负担；这些特征提供了对底层的重要洞察住院机制。我将使用来自埃默里移植中心的更详细的数据，该中心是全国最大的移植中心，以确定这些新结果中的种族差异。完成这些目标后，我将确定适合移植中心的特征减少结果种族差异的干预措施，量化医院差异的潜在影响再入院的生存差异，并确定了不同种族住院特征的差异。每个这些目标有助于实现我的长期目标，即为未来的多层次干预措施提供信息，以改善患者护理并减少肝移植受者之间的不平等。