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

doi:10.1016/j.amjsurg.2024.116023

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

Am J Surg. 2024 Oct 20:116023. doi: 10.1016/j.amjsurg.2024.116023. Online ahead of print.

Authors

Affiliations

¹ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
² 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
³ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
⁴ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
⁵ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
⁶ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
⁷ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
⁸ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
⁹ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
¹⁰ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].
¹¹ 660 South Euclid Avenue, Campus Box 8109, Washington University in St. Louis, St. Louis, MO, 63110, USA. Electronic address: [email protected].

PMID: 39505603
DOI: 10.1016/j.amjsurg.2024.116023

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 (HR_3rd = 0.94, HR_4th = 0.92, HR_5th = 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.

Keywords: Geographic disparities; Liver transplant; Primary care physicians.