title: The Effect of Hospital Characteristics on Racial/Ethnic Variation in Cirrhosis Mortality.
abstract: Racial/ethnic disparities in liver disease and cirrhosis are well established. Cirrhosis mortality is improving overall despite vast differences between hospitals. We sought to understand the hospital characteristics where minorities seek care, whether disparities in cirrhosis mortality persist, and determine how hospital differences contribute to these differences.
  
  
  
  We used data from the Nationwide Inpatient Sample and the American Hospital Association to identify inpatient episodes of care for cirrhosis and structural characteristics at the parent hospital. We used multi-level hierarchical regression models to understand the effect of hospital structural characteristics on racial/ethnic variation in cirrhosis mortality.
  
  
  
  From 2007 to 2011, 51,260 patients were admitted to the hospital with cirrhosis (White 66.5 %, Black 7.6 %, Hispanic 19.7 %, Asian 2.0 %, other 4.2 %). The overall adjusted mortality rate was 7.8 %, which significantly differed by race/ethnicity. Hospitals varied significantly in resource intensity. Higher mortality hospitals had a lower proportion of White patients and a higher proportion of Black and Hispanic patients compared to average and low mortality hospitals (p < 0.0001). Compared to White patients, there was significant racial/ethnic variation in unadjusted odds of mortality (Black OR 1.17; Hispanic OR 0.90; Asian 0.77; other 0.96; all p < 0.01). After accounting for hospital and patient differences, there were no racial/ethnic differences in mortality.
  
  
  
  The increased risk of cirrhosis mortality in Black patients appears to be mediated by facility differences and clinical co-morbidities, suggesting that access to higher quality health services at several points in both the early and late management of liver disease may improve disparate population outcomes.
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Apurba
authors.initials: A
authors.lastname: Chakrabarti
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.|Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Osborne
authors.affiliation: MedStar Georgetown Transplant Institute, Washington, DC, USA.
authors.forename: Amol S
authors.initials: AS
authors.lastname: Rangnekar
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA. mathur.amit@mayo.edu.|Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Phoenix, AZ, USA. mathur.amit@mayo.edu.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D015897:Comorbidity; D016208:Databases, Factual; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D019698:Hepatitis C, Chronic / Q000150:complications; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008103:Liver Cirrhosis / Q000208:ethnology / Q000209:etiology / Q000401:mortality*; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality; D008105:Liver Cirrhosis, Biliary / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011787:Quality of Health Care; D012044:Regression Analysis; D014481:United States; D044465:White People / Q000706:statistics & numerical data
keywords: Cirrhosis; Disparities; Hospitals; Outcomes