TY - JOUR
T1 - The Hispanic Paradox in Patients with Liver Cirrhosis
T2 - Current Evidence from a Large Regional Retrospective Cohort Study
AU - Atiemo, Kofi
AU - Mazumder, Nikhilesh R.
AU - Caicedo, Juan C.
AU - Ganger, Daniel
AU - Gordon, Elisa
AU - Montag, Samantha
AU - Maddur, Haripriya
AU - Vanwagner, Lisa B.
AU - Goel, Satyender
AU - Kho, Abel
AU - Abecassis, Michael
AU - Zhao, Lihui
AU - Ladner, Daniela
N1 - Funding Information:
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
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85075805277&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075805277&partnerID=8YFLogxK
U2 - 10.1097/TP.0000000000002733
DO - 10.1097/TP.0000000000002733
M3 - Article
C2 - 30951016
AN - SCOPUS:85075805277
SN - 0041-1337
VL - 103
SP - 2531
EP - 2538
JO - Transplantation
JF - Transplantation
IS - 12
ER -