TY - JOUR
T1 - Geographic disparities in primary care physicians
T2 - Local impact on long-term outcomes in adult liver transplant recipients
AU - Hill, Angela L.
AU - Park, Yikyung
AU - Wang, Mei
AU - Halpern, Samantha
AU - Kiani, Amen Z.
AU - Vachharajani, Neeta
AU - Olumba, Franklin C.
AU - Campbell, Sally
AU - Khan, Adeel S.
AU - Chapman, William C.
AU - Doyle, Majella B.
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
KW - Geographic disparities
KW - Liver transplant
KW - Primary care physicians
UR - http://www.scopus.com/inward/record.url?scp=85208186318&partnerID=8YFLogxK
U2 - 10.1016/j.amjsurg.2024.116023
DO - 10.1016/j.amjsurg.2024.116023
M3 - Article
C2 - 39505603
AN - SCOPUS:85208186318
SN - 0002-9610
JO - American journal of surgery
JF - American journal of surgery
M1 - 116023
ER -