Fewer deaths from alcohol-related disease in areas with higher-density gastroenterologists
Click Here to Manage Email Alerts
Higher state-level geographic density of gastroenterologists was linked with decreased mortality from alcohol-associated liver disease in adults aged 25 years or older, according to new data in Clinical Gastroenterology and Hepatology.
“We found significant disparities in where gastroenterologists are concentrated — the highest concentration being in Mid-Atlantic states and lowest in Mountain states,” study investigator Brian P. Lee, MD, MAS, told Healio. “Higher concentration of gastroenterologists correlated with lower deaths from alcohol-associated liver disease. These findings persisted even controlling for access to other subspecialties, access to transplant, access to mental health services, county-level differences, rural vs. urban differences and differences in alcohol taxation.”
Lee and colleagues from the University of Southern California, Los Angeles, also found a fivefold difference in the geographic density of gastroenterologists and mortality from alcohol-associated liver disease (ALD) across the U.S. Disparities in the geographic density of these specialists could represent 40% of ALD deaths in the nation, according to the researchers.
“Alcohol-associated liver disease is a public health crisis — alcohol accounts for half of liver-related deaths and liver transplants for alcohol-associated liver disease has increased fivefold in the past 20 years,” Lee said. “Policymakers and medical societies should address workforce gaps in gastroenterology as a potential way to address this problem.”
Using national data from five federally maintained registries, researchers assessed the association of state-level geographic density of gastroenterologists with ALD-related mortality among adults aged 25 years or older from 2010 to 2019.
After adjusting their findings for potential confounders, such as age, sex, race and ethnicity, investigators reported the national mean geographic density of gastroenterologists was 4.6 per 100,000 population. The mean annual ALD-related mortality rate for the nation was 85.6 per 1 million population.
Multivariable analysis revealed a significant association between geographic density of gastroenterologists and decreased ALD-related mortality, with nine fewer deaths per 1 million population for each additional specialist per 100,000 population. The threshold for this association was 7.5 gastroenterologists per 100,000 population.
“We were surprised that state-level concentrations of treatment centers for alcohol use disorder, substance use and mental health counselors, and transplant surgeons were not associated with deaths from alcohol-associated liver disease,” Lee said. “Substance use treatment and liver transplant has strong evidence to improve health in patients with alcohol-associated liver disease. We think that we did not see a correlation in our state-level analysis because, even if these resources exist locally, not everyone can or will access them.”
According to researchers, limitations of the study include that not all gastroenterologists practice hepatology, there was not a hepatology-specific variable in the searched databases, the data were observational and aggregate, and there was potential for misclassification of cause of death.
Still, Lee said, this research could help create “meaningful and effective” policies to close the gaps in the gastroenterology workforce and address disparities in alcohol- and liver-related health care.
He continued, “Ensuring access to gastroenterologists throughout the country could be an important intervention to address the epidemic of alcohol-associated liver disease, which is currently at record rates and climbing.”
Collapse
Read more about
Click Here to Manage Email Alerts