TY - JOUR
T1 - Social Disadvantage and Disparities in Chronic Liver Disease
T2 - A Systematic Review
AU - Hasjim, Bima J.
AU - Harris, Alexandra
AU - Balbale, Salva N.
AU - Obayemi, Joy E.
AU - Beestrum, Molly
AU - Polineni, Praneet
AU - Paukner, Mitchell
AU - Mohammadi, Mohsen
AU - Dentici, Oriana C.
AU - Kershaw, Kiarri N.
AU - Lewis-Thames, Marquita W.
AU - Mehrotra, Sanjay
AU - Ladner, Daniela P.
N1 - Publisher Copyright:
Copyright © 2024 The Author(s).
PY - 2024
Y1 - 2024
N2 - Introduction:Social determinants of health (SDOH) may impact chronic liver disease (CLD) outcomes but are not clearly understood. We conducted a systematic review to describe the associations of SDOH with mortality, hospitalizations, and readmissions among patients with CLD.Methods:This review was registered (PROSPERO ID: CRD42022346654) and identified articles through MEDLINE, Embase, Cochrane Library, and Scopus databases. The review included studies that reported SDOH characteristics within the domains of economic stability, health care access, education, social and community context, and the neighborhood built environment. Associated outcomes of interest were mortality, hospitalizations, or readmissions. The Cochrane Risk of Bias in Non-randomized Studies for Exposure (ROBINS-E) was used to assess study quality and risk of bias.Results:A total of 5,205 abstracts were screened, 60 articles underwent full-text review, and 27 articles were included in the final review. Poor economic stability, healthcare access, social support, and household/environmental conditions were associated with higher mortality and hospital readmissions among patients with CLD. Increasing distance (≥25 miles away) from a liver transplantation (LT) center was associated with higher mortality despite increasing access to the LT waitlist. When assessing the overall risk of bias among included studies, most had "Some Concern"(N=13, 48.1%) or "High Risk"(N=11, 40.7%) while a minority had "Very High Risk"(N=3, 11.1%). No studies were categorized as "Low Risk."Conclusions:Unfavorable SDOH were associated with increased mortality and hospital readmissions among patients with CLD. Rigorous empirical research is needed to identify evidence-based strategies that aim to mitigate disparities among vulnerable populations.
AB - Introduction:Social determinants of health (SDOH) may impact chronic liver disease (CLD) outcomes but are not clearly understood. We conducted a systematic review to describe the associations of SDOH with mortality, hospitalizations, and readmissions among patients with CLD.Methods:This review was registered (PROSPERO ID: CRD42022346654) and identified articles through MEDLINE, Embase, Cochrane Library, and Scopus databases. The review included studies that reported SDOH characteristics within the domains of economic stability, health care access, education, social and community context, and the neighborhood built environment. Associated outcomes of interest were mortality, hospitalizations, or readmissions. The Cochrane Risk of Bias in Non-randomized Studies for Exposure (ROBINS-E) was used to assess study quality and risk of bias.Results:A total of 5,205 abstracts were screened, 60 articles underwent full-text review, and 27 articles were included in the final review. Poor economic stability, healthcare access, social support, and household/environmental conditions were associated with higher mortality and hospital readmissions among patients with CLD. Increasing distance (≥25 miles away) from a liver transplantation (LT) center was associated with higher mortality despite increasing access to the LT waitlist. When assessing the overall risk of bias among included studies, most had "Some Concern"(N=13, 48.1%) or "High Risk"(N=11, 40.7%) while a minority had "Very High Risk"(N=3, 11.1%). No studies were categorized as "Low Risk."Conclusions:Unfavorable SDOH were associated with increased mortality and hospital readmissions among patients with CLD. Rigorous empirical research is needed to identify evidence-based strategies that aim to mitigate disparities among vulnerable populations.
KW - Social determinants of health
KW - chronic liver disease
KW - community
KW - socioeconomic status
KW - transplant
KW - waitlist
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U2 - 10.14309/ajg.0000000000003171
DO - 10.14309/ajg.0000000000003171
M3 - Article
C2 - 39471468
AN - SCOPUS:85210080662
SN - 0002-9270
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
M1 - 10.14309/ajg.0000000000003171
ER -