Geographic disparities in primary care physicians: Local impact on long-term outcomes in adult liver transplant recipients

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2024-10-20 DOI:10.1016/j.amjsurg.2024.116023

Angela L. Hill, Yikyung Park, Mei Wang, Samantha Halpern, Amen Z. Kiani, Neeta Vachharajani, Franklin C. Olumba, Sally Campbell, Adeel S. Khan, William C. Chapman, Majella B. Doyle

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Abstract

Background

Geographic inequities are known to affect access to liver transplant (LT); however, the impact of these disparities postoperatively remains unknown. We focus on primary care physicians (PCPs), as frequent managers of long-term LT recipient care.

Methods

Clinical data on adults undergoing liver-only transplant 2010–2021 were obtained from the Organ Procurement and Transplantation Network and linked to zip code-based PCP density and social vulnerability index (SVI) data to quantify the impact of PCP density on graft and overall survival.

Results

64,593 patients were divided into quintiles by PCP density. Compared to patients in the lowest PCP quintile, patients in the 3rd, 4th, and 5th quintiles had 6%–8% lower mortality risk (HR_3rd = 0.94, HR_4th = 0.92, HR_5th = 0.94, p for trend = 0.002). PCP density remained significant after accounting for SVI and local surgeon and gastroenterologist availability (p = 0.002).

Conclusions

Increased PCP availability is associated with improved survival, emphasizing the importance of establishing longitudinal care.

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初级保健医生的地域差异：当地对成人肝移植受者长期疗效的影响。

背景：众所周知，地域不平等会影响肝移植（LT）的获得；然而，这些不平等在术后产生的影响仍不为人知。作为肝移植受者长期护理的经常管理者，我们将重点放在初级保健医生（PCP）身上：方法：我们从器官获取与移植网络（Organ Procurement and Transplantation Network）获取了 2010-2021 年接受纯肝移植手术的成人临床数据，并将其与基于邮政编码的初级保健医生密度和社会脆弱性指数（SVI）数据联系起来，以量化初级保健医生密度对移植物和总体存活率的影响：64,593名患者按PCP密度被分为五等分。与 PCP 密度最低的五分位数患者相比，第三、第四和第五五分位数患者的死亡风险降低了 6%-8%（HR3rd = 0.94，HR4th = 0.92，HR5th = 0.94，趋势 p = 0.002）。在考虑了SVI、当地外科医生和胃肠病医生的可用性后，初级保健医生的密度仍具有显著意义（P = 0.002）：结论：增加初级保健医生的可用性与生存率的提高有关，强调了建立纵向护理的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.