Geographic disparities in primary care physicians: Local impact on long-term outcomes in adult liver transplant recipients

Angela L. Hill, Yikyung Park, Mei Wang, Samantha Halpern, Amen Z. Kiani, Neeta Vachharajani, Franklin C. Olumba, Sally Campbell, Adeel S. Khan, William C. Chapman, Majella B. Doyle

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Geographic inequities are known to affect access to liver transplant (LT); however, the impact of these disparities postoperatively remains unknown. We focus on primary care physicians (PCPs), as frequent managers of long-term LT recipient care. Methods: Clinical data on adults undergoing liver-only transplant 2010–2021 were obtained from the Organ Procurement and Transplantation Network and linked to zip code-based PCP density and social vulnerability index (SVI) data to quantify the impact of PCP density on graft and overall survival. Results: 64,593 patients were divided into quintiles by PCP density. Compared to patients in the lowest PCP quintile, patients in the 3rd, 4th, and 5th quintiles had 6%–8% lower mortality risk (HR3rd ​= ​0.94, HR4th ​= ​0.92, HR5th ​= ​0.94, p for trend ​= ​0.002). PCP density remained significant after accounting for SVI and local surgeon and gastroenterologist availability (p ​= ​0.002). Conclusions: Increased PCP availability is associated with improved survival, emphasizing the importance of establishing longitudinal care.

Original languageEnglish
Article number116023
JournalAmerican journal of surgery
DOIs
StateAccepted/In press - 2024

Keywords

  • Geographic disparities
  • Liver transplant
  • Primary care physicians

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