O-18 ETHNIC DISPARITIES IN HISPANIC POPULATION WITH ALCOHOL ASSOCIATED LIVER DISEASE AND TRANSPLANT ENLISTED PATIENTS: A RETROSPECTIVE STUDY OF TWO LARGE DATABASES IN THE UNITED STATES FROM 2011-2018

Introduction and Objectives

there are different variables in patients with alcohol associated liver disease (ALD) and enlisted patients for liver transplant (LT), such as ethnicity, that determine health disparities in access, morbidity and mortality. This study aimed to assess and measure the impact of ethnicity in ALD and patients enlisted for LT.

Materials and Methods

we conducted a retrospective study using U.S databases, the National Health and Nutrition Examination Survey (NHANES) and the United Network for Organ Sharing (UNOS) from 2011 to 2018. We created a multivariate model analyzing the clinical characteristics of the interviewed patients for NHANES. Alcohol consumption and ethnicity were self-reported. We also created a competing risks model for time to LT in enlisted patients.

Results

of the 39,156 interviewed patients, 17.1% identified as Hispanic. In this group, the prevalence of ALD was 9.0% and the average consumption of pure alcohol was 2.3 L/year. The multivariate-adjusted model showed that Hispanics were independently associated with a higher risk of ALD (OR 1.30; 95%CI: 1.05-1.60, p=0.018). Of the enlisted patients, 13.6% were Hispanic. White ethnicity, lower age, male sex, higher MELD score, renal failure, lower BMI, higher education and private insurance were associated with a higher rate of LT. Hispanics were independently associated with a lower LT (HR 0.80; 95%CI: 0.74-0.87, p<0.001).

Conclusions

ethnicity is an important factor in healthcare outcomes. This is a growing area of interest, and research should be carried out to better our understanding of the impact that these disparities have on patients. Studying ethnic minority groups is needed to enable researchers to face the challenges of reducing and ultimately eliminating health disparities.

Tabla 1. Competitive Risk Model for Patients Enlisted for Liver Transplant

Variable	Univariate Model	P Value	Adjusted Multivariate Model	P Value
	hazard ratio (IC 95%)
Whites (ref)	ref	ref	ref	ref
vs Blacks	1.18 (1.07-1.31)	0.002	1.03 (0.87-1.23)	0.726
vs Hispanics	0.90 (0.85-0.95)	<0.001	0.80 (0.74-0.87)	<0.001
vs Asian	0.85 (0.72-1.00)	0.046	0.98 (0.82-1.19)	0.867
vs Other	0.83 (0.71-0.98)	0.026	0.82 (0.64-1.04)	0.100
Men	1.13 (1.08-1.18)	<0.001	1.01 (0.94-1.07)	0.875
Age at Enlistment	0.98 (0.98-0.99)	<0.001	0.99 (0.98-0.99)	<0.001
MELD (Model for End-Stage Liver disease)	1.26 (1.24-1.26)	<0.001	1.04 (1.03-1.05)	<0.001
Diabetes Mellitus	0.97 (0.92-1.02)	0.187	-	-
Hepatocellular carcinoma	1.02 (0.92-1.14)	0.66	-	-
Obesity	0.99 (0.98-0.99)	0.010	0.99 (0.98-0.99)	0.16
Renal Failure	1.60 (1.54-1.67)	<0.001	1.40 (1.32-1.47)	<0.001
Education <”High school”	ref	ref	ref	ref
Education “Some College”	1.03 (0.98-1.08)	0.195	0.99 (0.93-1.06)	0.860
Education “College-Bachelor”	1.07 (1.02-1.12)	0.006	1.04 (0.97-1.11)	0.263
Medicare	ref	ref	ref	ref
Medicaid	1.01 (0.93-1.11)	0.721	0.98 (0.89-1.09)	0.760
Private Insurance	1.18 (1.10-1.27)	<0.001	1.01 (0.93-1.10)	0.784