Evidence map›Paper›PMID 31332626›Full record

ArticleDigestive diseases and sciences2020

County Rankings Have Limited Utility When Predicting Liver Transplant Outcomes.

Clifford Akateh, Rebecca Miller, Eliza W Beal, Dmitry Tumin, Joseph D Tobias, Don Hayes, Sylvester M Black

Abstract read
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Article in Digestive diseases and sciences, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Clifford AkatehDivision of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Faculty Tower, 395 W 12th Ave, Room 654, Columbus, OH, 43210-1267, USA. clifford.akateh@osumc.edu.ORCID 0000-0003-2936-9779
Rebecca MillerDepartment of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
Eliza W BealDivision of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Faculty Tower, 395 W 12th Ave, Room 654, Columbus, OH, 43210-1267, USA.
Dmitry TuminDepartment of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, 27834, USA.
Joseph D TobiasDepartment of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
Don HayesDivision of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
Sylvester M BlackDivision of Transplantation, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.

Funding

Advanced Research Training in Immunology for Surgery Trainees (ARTIST)T32AI106704 · NIAID · OHIO STATE UNIVERSITY · PI GINNY L BUMGARDNER, Jon R Wisler · 2014 to 2026
$3.5M
NIAID NIH HHS T32 AI106704
6 · The paper itself

Abstract

backgroundEvidence of geographical differences in liver transplantation (LT) outcomes has been proposed as a reason to include community characteristics in risk adjustment of transplant quality metrics. However, consistency and utility of rankings in LT outcomes for counties have not been demonstrated.

aimsWe sought to evaluate the utility of county rankings (county socioeconomic status (SES) or county health scores (CHS)) on outcomes after LT.

methodsUsing the United Network for Organ Sharing Registry, adults ≥ 18 years of age undergoing LT between 2002 and 2014 were identified. County-specific 1-year survival was calculated using the Kaplan-Meier method for counties with ≥ 5 LT performed during this period. Agreement between high-risk designation by 1-year mortality rate and county ranking was calculated using the Spearman correlation coefficient.

resultsThe analysis included 47,769 LT recipients in 1092 counties. County 1-year mortality rates were not correlated with county CHS (Spearman ρ = 0.01, p = 0.694) or county SES (Spearman ρ = - 0.01, p = 0.734). After controlling for individual-level covariates, a statistically significant variability in mortality hazards across counties (p < 0.001) persisted. Although both CHS and SES measures improved the model fit (p = 0.004 and p = 0.048, respectively), an unexplained residual variation in mortality hazard across counties continued.

conclusionsThere is poor agreement between county rankings on various socioeconomic indicators and LT outcomes. Although there is variability in outcomes across counties, this appears not to be due to county-level socioeconomic indices.

Indexed as

Healthcare DisparitiesHealth Status IndicatorsOutcome and Process Assessment, Health CareResidence CharacteristicsSocial ClassSocial Determinants of HealthAdultFemaleHumansLiver TransplantationMaleMiddle AgedRegistriesRisk AssessmentRisk FactorsTreatment OutcomeCounty health scoresCounty socioeconomic statusHumanLiver transplantationRisk adjustmentSocioeconomic factorsSurvival

Identifiers

PMID31332626
PMCPMC6946869

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