title: Access to primary care is associated with better autoimmune hepatitis outcomes in an urban county hospital.
abstract: BACKGROUND
  Autoimmune hepatitis causes chronic hepatitis and often leads to cirrhosis and death without treatment. We wanted to see if having access to primary care or insurance prior to diagnosis is associated with better outcomes for patients in an urban, public hospital with mostly socioeconomically disadvantaged Hispanic patients.
  
  
  METHODS
  We did a retrospective study at our institution. Kaplan Meier survival analysis was done looking at transplant-free overall survival for patients diagnosed at our institution. The log-rank test was done to compare survival between patients with and without prior access to primary care, and between patients with and without insurance at diagnosis.
  
  
  RESULTS
  Overall 5- and 10-year transplant-free overall survival was 91% (95% CI, 83-100%) and 75% (95% CI, 50-99%), respectively. Patients with primary care prior to diagnosis had significantly better transplant-free overall survival than those without (log rank test p = 0.019). Patients with primary care also had better clinical markers at diagnosis. Having insurance at diagnosis was not associated with better outcomes.
  
  
  CONCLUSIONS
  Outcomes of autoimmune hepatitis are poor in our setting but access to primary care prior to diagnosis was associated with better outcomes. This is likely due to the important role that primary care plays in detecting disease and initiating treatment earlier. With the expansion of access to healthcare that the Affordable Care Act provides, future patients are likely to do better with even rare diseases like autoimmune hepatitis.
authors.affiliation: Department of Medicine, Harbor-UCLA Medical Center, 1000 W. Carson St., Box 400, Torrance, CA, 90509, USA. dannerkim@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Medicine, Harbor-UCLA Medical Center, 1000 W. Carson St., Box 400, Torrance, CA, 90509, USA. danesh0123@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eshtiaghpour
authors.affiliation: Department of Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA, USA. joelalpern@yahoo.com.
authors.forename: Joel
authors.initials: J
authors.lastname: Alpern
authors.affiliation: Department of Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA, USA. anujdatta@hotmail.com.
authors.forename: Anuj
authors.initials: A
authors.lastname: Datta
authors.affiliation: Department of Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA, USA. veysselein@labiomed.org.
authors.forename: Viktor E
authors.initials: VE
authors.lastname: Eysselein
authors.affiliation: Department of Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA, USA. hyee@dhs.lacounty.gov.|Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. hyee@dhs.lacounty.gov.
authors.forename: Hal F
authors.initials: HF
authors.lastname: Yee
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D019693:Hepatitis, Autoimmune / Q000401:mortality / Q000628:therapy*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006766:Hospitals, County; D006786:Hospitals, Urban; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016031:Liver Transplantation; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015996:Survival Rate