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More GI Docs, Fewer Alcoholic Liver Disease Deaths


Areas with more gastroenterologists had fewer deaths from alcohol-associated liver disease (ALD), a national study found.

Each additional GI specialist per 100,000 population was associated with 0.9 fewer ALD-related deaths in that population, according to a multivariable regression analysis by Brian Lee, MD, PhD, of the University of Southern California in Los Angeles, and colleagues.

That significant association plateaued at about 7.5 gastroenterologists for every 100,000 people, suggesting a potential density of gastroenterologists to target, the authors wrote in Clinical Gastroenterology and Hepatology.

A state that hit that mark had 34.3 fewer ALD deaths per million than states in the lowest quartile for number of gastroenterologists (3.7 per 100,000 people) — and that difference in access to care could account for some 40% of national ALD-related deaths, the researchers estimated.

“The key takeaway from the study is that ways to increase access to gastroenterologist care across the nation may be an important tool to address health disparities and the epidemic of rising deaths from alcohol-associated liver disease,” Lee told MedPage Today. “We need more tools to be able to address this public health problem, and we wanted to see whether workforce gaps are an important area to focus.”

These results illuminate healthcare inequalities and “could assist professional societies, governmental agencies, and payers as they focus on addressing gaps in care,” Andrew Talal, MD, of the University at Buffalo in New York, who was not involved in the study, told MedPage Today.

ALD is growing fastest in populations that include racial minorities, women, and young adults. Previous Veterans Affairs studies have only shown lower mortality rates for liver disease patients who visited a gastroenterologist any time after being diagnosed and for hepatocellular carcinoma patients who visited a hepatologist within 30 days of their diagnosis.

For this study, Lee and colleagues examined data from five federal registries — U.S. Census, WONDER, Behavioral Risk Factor Surveillance System, National Survey of Substance Abuse Treatment Services, as well as the Health Resources and Services Administration — on ALD-related deaths between 2010 and 2019. Included were adults who were ages 25 and up.

For gastroenterologists, the national mean geographic density was 4.6 per 100,000 people during 2019, while the ALD-related death rate was 85.6 per one million population during 2010-2019 across the continental states and District of Columbia.

Over a five-fold difference was seen between states for the geographic density of gastroenterologists (ranging from 10.1 per 100,000 in the District of Columbia to 1.8 per 100,000 in Alaska) and the ALD-related deaths (ranging from 289 per million in Wyoming to 52 per million in New Jersey).

“Mid-Atlantic states had the highest geographic density of gastroenterologists and lowest ALD-related mortality, whereas mountain states had the lowest geographic density of gastroenterologists and highest ALD-related mortality,” they noted.

Despite having higher rates of harmful alcohol use and fibrosis, Black individuals had lower ALD-related death rates and an overall lower ALD prevalence than whites and Hispanics.

The analysis adjusted for demographics and other confounders.

Exploratory analyses showed no change in the findings with adjustment for confounding based on transplant access, state-level alcohol taxation, subspecialty care, mental health services, and substance use, among other factors.

In 2019, 52% of ALD-related deaths were among women and nearly two-thirds occurred in white individuals (64%), while 31% had obesity, 15% were smokers, and 11% had diabetes.

The authors acknowledged limitations to the data, including the fact that not all gastroenterologists practice hepatology. Additionally, federal databases omit hepatology-specific variables, and advanced care providers such as nurse practitioners were excluded.

  • Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.

Disclosures

This study was supported by the University of Southern California Research Center for Liver Diseases.

Lee and coauthors reported no conflicts of interest.



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