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Social Disadvantage and Disparities in Chronic Liver Disease: A Systematic Review.
The American Journal of Gastroenterology ( IF 8.0 ) Pub Date : 2024-10-30 , DOI: 10.14309/ajg.0000000000003171 Bima J Hasjim,Alexandra Harris,Salva N Balbale,Joy E Obayemi,Molly Beestrum,Praneet Polineni,Mitchell Paukner,Mohsen Mohammadi,Oriana C Dentici,Kiarri N Kershaw,Marquita W Lewis-Thames,Sanjay Mehrotra,Daniela P Ladner
The American Journal of Gastroenterology ( IF 8.0 ) Pub Date : 2024-10-30 , DOI: 10.14309/ajg.0000000000003171 Bima J Hasjim,Alexandra Harris,Salva N Balbale,Joy E Obayemi,Molly Beestrum,Praneet Polineni,Mitchell Paukner,Mohsen Mohammadi,Oriana C Dentici,Kiarri N Kershaw,Marquita W Lewis-Thames,Sanjay Mehrotra,Daniela P Ladner
INTRODUCTION
Social determinants of health (SDOH) may impact chronic liver disease (CLD) outcomes but are not clearly understood. We conducted a systematic review to describe the associations of SDOH with mortality, hospitalizations, and readmissions among patients with CLD.
METHODS
This review was registered (PROSPERO ID: CRD42022346654) and identified articles through MEDLINE, Embase, Cochrane Library, and Scopus databases. The review included studies that reported SDOH characteristics within the domains of economic stability, health care access, education, social and community context, and the neighborhood built environment. Associated outcomes of interest were mortality, hospitalizations, or readmissions. The Cochrane Risk of Bias in Non-randomized Studies for Exposure (ROBINS-E) was used to assess study quality and risk of bias.
RESULTS
A total of 5,205 abstracts were screened, 60 articles underwent full-text review, and 27 articles were included in the final review. Poor economic stability, healthcare access, social support, and household/environmental conditions were associated with higher mortality and hospital readmissions among patients with CLD. Increasing distance (≥25 miles away) from a liver transplantation (LT) center was associated with higher mortality despite increasing access to the LT waitlist. When assessing the overall risk of bias among included studies, most had "Some Concern" (N=13, 48.1%) or "High Risk" (N=11, 40.7%) while a minority had "Very High Risk" (N=3, 11.1%). No studies were categorized as "Low Risk."
CONCLUSIONS
Unfavorable SDOH were associated with increased mortality and hospital readmissions among patients with CLD. Rigorous empirical research is needed to identify evidence-based strategies that aim to mitigate disparities among vulnerable populations.
中文翻译:
慢性肝病的社会劣势和差异:系统评价。
引言 健康的社会决定因素 (SDOH) 可能会影响慢性肝病 (CLD) 的结局,但尚不清楚。我们进行了一项系统评价,以描述 SDOH 与 CLD 患者死亡率、住院和再入院率的关联。方法 本综述已注册 (PROSPERO ID: CRD42022346654) 并通过 MEDLINE、Embase、Cochrane Library 和 Scopus 数据库确定了文章。该综述包括报告经济稳定性、医疗保健可及性、教育、社会和社区环境以及社区建筑环境等领域的 SDOH 特征的研究。感兴趣的相关结局是死亡率、住院率或再入院率。Cochrane 非随机暴露研究偏倚风险 (ROBINS-E) 用于评估研究质量和偏倚风险。结果 共筛选出 5,205 篇摘要,全文评审 60 篇,终评 27 篇。经济稳定性差、医疗保健可及性、社会支持和家庭/环境条件与 CLD 患者较高的死亡率和再入院率相关。尽管 LT 候补名单的访问增加,但距肝移植 (LT) 中心的距离增加(≥25 英里)与较高的死亡率相关。在评估纳入研究的总体偏倚风险时,大多数研究有 “一些担忧” (N=13, 48.1%) 或 “高风险” (N=11, 40.7%),而少数研究有 “非常高风险” (N=3, 11.1%)。没有研究被归类为 “低风险”。结论 不良 SDOH 与 CLD 患者死亡率和再入院率增加相关。 需要严格的实证研究来确定旨在减轻弱势群体之间差异的循证策略。
更新日期:2024-10-30
中文翻译:
慢性肝病的社会劣势和差异:系统评价。
引言 健康的社会决定因素 (SDOH) 可能会影响慢性肝病 (CLD) 的结局,但尚不清楚。我们进行了一项系统评价,以描述 SDOH 与 CLD 患者死亡率、住院和再入院率的关联。方法 本综述已注册 (PROSPERO ID: CRD42022346654) 并通过 MEDLINE、Embase、Cochrane Library 和 Scopus 数据库确定了文章。该综述包括报告经济稳定性、医疗保健可及性、教育、社会和社区环境以及社区建筑环境等领域的 SDOH 特征的研究。感兴趣的相关结局是死亡率、住院率或再入院率。Cochrane 非随机暴露研究偏倚风险 (ROBINS-E) 用于评估研究质量和偏倚风险。结果 共筛选出 5,205 篇摘要,全文评审 60 篇,终评 27 篇。经济稳定性差、医疗保健可及性、社会支持和家庭/环境条件与 CLD 患者较高的死亡率和再入院率相关。尽管 LT 候补名单的访问增加,但距肝移植 (LT) 中心的距离增加(≥25 英里)与较高的死亡率相关。在评估纳入研究的总体偏倚风险时,大多数研究有 “一些担忧” (N=13, 48.1%) 或 “高风险” (N=11, 40.7%),而少数研究有 “非常高风险” (N=3, 11.1%)。没有研究被归类为 “低风险”。结论 不良 SDOH 与 CLD 患者死亡率和再入院率增加相关。 需要严格的实证研究来确定旨在减轻弱势群体之间差异的循证策略。