ZIP code, social vulnerability affect access to liver transplant in alcohol-related disease
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Key takeaways:
- Approximately 80% of ZIP codes with early liver transplant recipients were within 50 miles of the transplant center.
- ZIP codes with high social vulnerability were less likely to have transplant recipients.
Most recipients of early liver transplant for severe alcohol-related liver disease live in close proximity to transplant centers, which are more likely to be in socially advantaged areas, according to research in Gastro Hep Advances.
“Some LT centers have adopted the practice of early liver transplants (ELT) for candidates with severe alcohol-related liver disease (ALD) and less than 6-month alcohol-free periods,” James Flanary, of the department of surgery at Johns Hopkins University, and colleagues wrote. “The practice defers some or all addiction interventions until after the transplant and has similar post-surgical outcomes as standard LT after at least 6 months of alcohol abstinence. However, factors that influence patient access to ELT are incompletely described.”
To investigate whether social determinants of health affect ELT access for patients with severe ALD, Flanary and colleagues performed a cross-sectional analysis of 6,206 ZIP codes within a 150-nautical mile radius of four transplant centers in Baltimore; Weston, Florida; Cleveland; and San Francisco.
The researchers compared neighborhoods in which individuals did and did not have access to ELT and collected alcohol-related use and mortality variables from the CDC, National Survey on Drug Use and Health, and County Health Rankings.
Flanary and colleagues identified 156 recipients who underwent ELT between January 2019 and April 2023 in 138 ZIP codes. In terms of racioethnicity, white was the most represented group for ZIP codes with (78%) and without (87%) ELT recipients, and about 80% of ZIP codes with recipients were within 50 nautical miles of the transplant center.
Results also demonstrated ALD mortality rates of four deaths per 100,000 per year in ZIP codes with recipients vs. 4.2 deaths in those without, suggesting that social vulnerability increases with distance from transplant centers.
Unadjusted analysis confirmed the relationship between ZIP codes with high vs. low social vulnerability and likelihood of having ELT recipients (OR = 0.46; 95% CI, 0.23-0.92), although the effect size “became negligible” following adjustment for distance to a center (adjusted OR = 0.99; 95% CI, 0.42-2.37).
“Our cross-sectional study of four transplant centers from different regions of the United States found that most ELT recipients come from ZIP codes in close proximity to transplant centers, where more socially advantaged ZIP codes tend to be,” Flanary and colleagues wrote. “Our observations provide an original geographical view of social determinants of health data to investigate their potential roles in informing the listing process and access to ELT. Further analyses are necessary to understand how social determinants of health may affect access to LT differently across regions.”
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