Racial Disparities in Cirrhosis-Related Healthcare Outcomes Among Hospitalized Patients

Introduction: Racial disparities may exist in the receipt of cirrhosis-related care. Studies have shown that Black patients may be less likely to receive liver transplantation and have worse graft survival compared to Whites. Asian and Pacific Islander (API) Americans are disproportionately affected by chronic hepatitis B and some Asian ethnic groups (such as the Hmong) may have worse liver cancer survival compared to others. Methods: A retrospective study was performed among patients diagnosed with cirrhosis admitted within the past 5 years (January 1, 2013 to present) to a tertiary care academic medical center. Patients were identified based on International Diagnosis Codes 9 or 10 for cirrhosis or its complications. Demographic information, laboratory data, major comorbidities, and adherence to cirrhosis quality care indicators were recorded to determine their relationship to re-admission rate and other healthcare outcomes. Results: A total of 463 individual patients with cirrhosis were identified including Whites (N=273), Hispanics (N=105), Blacks (N=23), and Asian and Pacific Islander Americans (API, N=15). The remaining 47 patients were categorized as Other. Compared to Whites, Blacks had higher mean MELD-Sodium scores (28.2±1.69 versus 26.5±0.57, P=0.002) and the highest proportion of cirrhosis from chronic hepatitis C compared to other races (52%, p=0.002). API patients have a higher proportion of diabetes mellitus (80%, p=0.012) and cirrhosis from chronic hepatitis B (7%, p=0.002) compared to other races. Regarding healthcare outcomes, Black patients had the highest mean total hospital admissions (5.65±1.26, p=0.006) and trended towards the highest mean number of 30-day re-admissions (2.17±0.80, P=0.067) compared to all other races. Compared to Whites, Black and API patients had a higher mean number of 90-day readmissions (0.81±0.09 versus 1.17±0.35 and 1.27±0.42, respectively, p=0.001). Adherence to most cirrhosis quality care indicators ranged from 87% to 100%. On univariable proportional odds regression analysis, Black race (p=0.001) and nonadherence to beta-blockers for variceal bleeding prophylaxis (p=0.016) were predictors of 90-day readmission. Conclusion: Black and API patients hospitalized for complications of cirrhosis may experience significant disparities in healthcare outcomes compared to Whites despite high quality cirrhosis care. Future studies should seek to determine the cause for these racial disparities in cirrhosis care.