TY - JOUR
T1 - Individual and neighborhood socioeconomic status in the prediction of liver transplantation among patients with liver disease
T2 - A population-based cohort study in Taiwan
AU - Liu, Chi Chu
AU - Lu, Chin Li
AU - Notobroto, Hari Basuki
AU - Tsai, Chiang Chin
AU - Wen, Pei Hung
AU - Li, Chung Yi
N1 - Publisher Copyright:
Copyright © 2019 the Author(s).
PY - 2019
Y1 - 2019
N2 - Given the fact that >80% of liver transplantations (LTs) were living donor liver transplantation (LDLT) in Taiwan, we conducted this study to assess whether patients with lower socioeconomic status are subject to a lower chance of receiving hepatic transplantation. This was a cohort study including 197,082 liver disease patients admitted in 1997 to 2013, who were at higher risk of LT. Personal monthly income and median family income of living areas were used to indicate individual and neighborhood socioeconomic status, respectively. Cox proportional hazard model that considered death as a competing risk event was used to estimate subdistribution hazard ratio (sHR) of LT in association with socioeconomic status. Totally 2204 patients received LT during follow-up, representing a cumulative incidence of 1.12% and an incidence rate of 20.54 per 104 person-years. After adjusting for potential confounders, including age, sex, co-morbidity, location/urbanization level of residential areas, we found that patients with < median monthly income experienced significantly lower incidence of LT (aHR=0.802, 95% confidence interval (CI)=0.717-0.898), but those with >- median monthly income had significantly elevated incidence of LT (aHR=1.679, 95% CI=1.482-1.903), as compared to those who were not actively employed. Additionally, compared to areas with the lowest quartile of median family income, the highest quartile of median family income was also associated with significantly higher incidence rate of LT (aHR=1.248, 95% CI=1.055-1.478). Higher individual and neighborhood socioeconomic status were significantly associated with higher incidence of LT among patients with higher risk of LT.
AB - Given the fact that >80% of liver transplantations (LTs) were living donor liver transplantation (LDLT) in Taiwan, we conducted this study to assess whether patients with lower socioeconomic status are subject to a lower chance of receiving hepatic transplantation. This was a cohort study including 197,082 liver disease patients admitted in 1997 to 2013, who were at higher risk of LT. Personal monthly income and median family income of living areas were used to indicate individual and neighborhood socioeconomic status, respectively. Cox proportional hazard model that considered death as a competing risk event was used to estimate subdistribution hazard ratio (sHR) of LT in association with socioeconomic status. Totally 2204 patients received LT during follow-up, representing a cumulative incidence of 1.12% and an incidence rate of 20.54 per 104 person-years. After adjusting for potential confounders, including age, sex, co-morbidity, location/urbanization level of residential areas, we found that patients with < median monthly income experienced significantly lower incidence of LT (aHR=0.802, 95% confidence interval (CI)=0.717-0.898), but those with >- median monthly income had significantly elevated incidence of LT (aHR=1.679, 95% CI=1.482-1.903), as compared to those who were not actively employed. Additionally, compared to areas with the lowest quartile of median family income, the highest quartile of median family income was also associated with significantly higher incidence rate of LT (aHR=1.248, 95% CI=1.055-1.478). Higher individual and neighborhood socioeconomic status were significantly associated with higher incidence of LT among patients with higher risk of LT.
KW - Cohort studies
KW - Liver transplantation
KW - Propensity score
KW - Socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85063294310&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000014849
DO - 10.1097/MD.0000000000014849
M3 - Article
C2 - 30882681
AN - SCOPUS:85063294310
SN - 0025-7974
VL - 98
JO - Medicine (United States)
JF - Medicine (United States)
IS - 11
M1 - e14849
ER -