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The Hispanic Paradox in Patients With Liver Cirrhosis

Current Evidence From a Large Regional Retrospective Cohort Study

Atiemo, Kofi MD1; Mazumder, Nikhilesh R. MD, MPH2; Caicedo, Juan C. MD1; Ganger, Daniel MD1,2; Gordon, Elisa PhD, MPH1,3; Montag, Samantha MS1,4; Maddur, Haripriya MD1,2; VanWagner, Lisa B. MD1,2,4; Goel, Satyender PhD5; Kho, Abel MD5; Abecassis, Michael MD1; Zhao, Lihui PhD1,4; Ladner, Daniela MD, MPH1,3

doi: 10.1097/TP.0000000000002733
Original Clinical Science—Liver
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Background. Despite lower socioeconomic status, Hispanics in the United States paradoxically maintain equal or higher average survival rates compared to non-Hispanic Whites (NHW).

Methods. We used multivariable Cox regression to assess whether this “Hispanic paradox” applies to patients with liver cirrhosis using a retrospective cohort of twenty 121 patients in a Chicago-wide electronic health record database.

Results. Our study population included 3279 (16%) Hispanics, 9150 (45%) NHW, 4432 (22%) African Americans, 529 (3%) Asians, and 2731 (14%) of other races/ethnic groups. Compared to Hispanics, NHW (hazard ratio [HR] 1.26; 95% confidence interval [CI], 1.16-1.37), African American (HR 1.26; 95% CI, 1.15-1.39), and other races/ethnic groups (HR 1.55; 95% CI, 1.40-1.71) had an increased risk of death despite adjustment for age, sex, insurance status, etiology of cirrhosis, and comorbidities. On stratified analyses, a mortality advantage for Hispanics compared to NHW was seen for alcohol cirrhosis (HR for NHW 1.35; 95% CI, 1.19-1.52), hepatitis B (HR for NHW 1.35; 95% CI, 0.98-1.87), hepatitis C (HR for NHW 1.21; 95% CI, 1.06-1.38), and nonalcoholic steatohepatitis (HR for NHW 1.14; 95% CI, 0.94-1.39). There was no advantage associated with Hispanic race over NHW in cases of hepatocellular carcinoma or cholestatic liver disease.

Conclusions. Hispanic patients with cirrhosis experience a survival advantage over many other racial groups despite adjustment for multiple covariates.

1 Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL.

2 Division of Hepatology, Department of Medicine, Feinberg School of Medicine, Chicago, IL.

3 Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Chicago, IL.

4 Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL.

5 Center for Health Information Partnerships, Institute for Public Health and Medicine, Feinberg School of Medicine, Chicago, IL.

Received 19 October 2018. Revision received 21 February 2019.

Accepted 1 March 2019.

K.A. and N.R.M. were supported by NIH grant T32DK077662. M.A. and L.B.V. were supported by NIH grant K23 HL136891.

The authors declare no conflicts of interest.

K.A. participated in research design, writing of the article, performance of the research, contributed new reagents or analytic tools, and participated in data analysis. N.R.M. participated in the writing of the article, performance of the research, contributed new reagents or analytic tools, and participated in data analysis. J.C.C. participated in research design. D.G. participated in research design. E.G. participated in research design. S.M. participated in the performance of the research, contributed new reagents or analytic tools, and participated in data analysis. H.M. participated in research design. L.B.V. participated in research design. S.G. participated in the performance of the research and contributed new reagents or analytic tools. A.K. participated in the performance of the research and contributed new reagents or analytic tools. M.A. participated in research design and the performance of the research. L.Z. contributed new reagents or analytic tools and participated in data analysis. D.L. participated in research design, writing of the article, performance of the research, contributed new reagents or analytic tools, and participated in data analysis.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Daniela P Ladner, MD, MPH, FACS, Department of Surgery, Division of Organ Transplantation Director Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 1900, Chicago, IL 60611. (dladner@nmh.org; danielaladner@gmail.com.

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