The Role of Socioeconomic Status and Race/Ethnicity in Orthotopic Liver Transplantation Outcomes in U.S. Adults Ages 50 and Older, 2002-2012

Orthotopic liver transplantation (OLT) currently represents a life-saving procedure used to extend and improve the quality of life for those with End-Stage Liver Disease (ESLD). However, this procedure, the gold standard of treatment for ESLD, is not readily accessible to all populations. Racial and socioeconomic disparities exist throughout the organ transplantation and specifically orthotopic liver transplantation system today. Research has shown that these social disparities impact the development and progression of any given disease, including ESLD. This study uses data from adults 50 years and older from 2002 – 2012 who underwent an orthotopic liver transplant procedure recorded in the Scientific Registry of Transplant Recipients (SRTR) and performs logistic regression analyses informed by two specific aims. To satisfy the overall objective of this investigation, which is to better understand the relationship between socioeconomic status (SES) and OLT outcomes, as well as the mechanisms behind race/ethnicity and SES disparities regarding OLT outcomes, two specific aims will be addressed. First, to assess the extent to which lower SES is associated with patient survival through the first-year post-OLT and examine a possible mediating effect that waitlist time has on the association in OLT occurring between 2002-2012. And second, to examine possible moderating effects race/ethnicity may have on the relationship between SES and the OLT outcome of patient survival during the first-year post-transplant occurring between 2002-2012 and comparing outcomes of both Hispanic and non-Hispanic Black patients to non-Hispanic White patients. The study was unique in that it utilized the first decade of OLT transplantation outcomes since the MELD score was implemented, as well as looked at one-year post-transplant Hispanic outcomes. Aim 1 results were mixed in that while it supported a connection between waitlist time, socioeconomic status, and death within one-year post-transplant, the waitlist was not significant as a mediator. Aim 2 results showed that there was a moderating effect of race/ethnicity on socioeconomic status and death within one-year post-transplant. It also supported the hypothesis that Hispanic patients have better first-year post-transplant outcomes than non-Hispanic Blacks. This study furthers our understanding of the problem of inequality and disparities as they relate to the interconnectedness of SES and race regarding liver allocation and immediate survival one-year post-OLT.

Name thesis:degree_name

Population Health Sciences (Doctoral)

Grantor

The University of Texas Medical Branch at Galveston

Year dc:date.issued

2022

Author dc:creator

• Dierking, Leah Anne

• Health Sciences, Epidemiology
• Health Sciences, General
• Health Sciences, Public Health

Handle dc:identifier.uri

https://hdl.handle.net/2152.3/12678

OAI identifier oai:identifier

oai:utmb-ir.tdl.org:2152.3/12678