title: Racial disparities in the management of hospitalized patients with cirrhosis and complications of portal hypertension: a national study.
abstract: Having complications of portal hypertension is a harbinger of decompensated cirrhosis and warrants consideration for liver transplantation (LT). Racial disparities in LT have been reported. We sought to characterize disparities in the performing of surgical and endoscopic procedures among hospitalized patients with complications of portal hypertension. We queried the Nationwide Inpatient Sample from 1998 to 2003 to identify patients with cirrhosis and complications of portal hypertension. Logistic regression controlling for confounders was used to evaluate race as a predictor of undergoing a portosystemic shunt and LT and of dying in the hospital. Compared to whites, the adjusted odds ratios of receiving a portosystemic shunt were 0.37 (95% CI: 0.27-0.51) and 0.69 (95% CI: 0.54-0.88) for African Americans (AAs) and Hispanics, respectively. AAs with variceal bleeding were more likely to have endoscopic variceal hemostasis delayed more than 24 hours after admission than were whites (OR 1.6; 95% CI: 1.2-2.1). The adjusted odds ratios of undergoing LT were 0.32 (95% CI:0.20-0.52) and 0.46 (95% CI: 0.25-0.83) for AAs and Hispanics, respectively. Compared to whites, AAs experienced higher in-hospital mortality (OR 1.12; 95% CI: 1.01-1.24), whereas Hispanics had a lower risk of death (OR 0.83; 95% CI: 0.75-0.92). Among variceal bleeders, the odds ratio of death for AAs was 1.7 (95% CI: 1.2-2.4) compared to whites.
  
  
  CONCLUSIONS
  AAs and Hispanics hospitalized for complications of portal hypertension were less likely to undergo a palliative shunt or LT than whites, which may contribute to the higher in-hospital mortality of AAs. Further studies are warranted to elucidate the mechanisms of these exploratory findings.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Thuluvath
mesh_terms: D044383:Black People / Q000706:statistics & numerical data*; D004724:Endoscopy / Q000706:statistics & numerical data; D004932:Esophageal and Gastric Varices / Q000208:ethnology / Q000628:therapy; D006489:Hemostatic Techniques / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000208:ethnology* / Q000628:therapy*; D007350:Insurance, Hospitalization / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000208:ethnology* / Q000628:therapy*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D011170:Portasystemic Shunt, Surgical / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American