More GI Docs, Fewer Alcoholic Liver Disease Deaths

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

Each additional gastrointestinal specialist per 100,000 population was associated with 0.9 fewer ALD-related deaths in this population, according to a multivariate regression analysis by Brian Lee, MD, PhD, of the University of California du South in Los Angeles, and his colleagues.

This significant association peaked at about 7.5 gastroenterologists per 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 the number of gastroenterologists (3.7 per 100,000 people) — and that difference in access to care could account for about 40% of national ALD-related deaths, the researchers estimated.

“The main conclusion of the study is that ways to increase access to gastroenterologist care across the country can be an important tool in addressing the growing health disparities and epidemic of deaths due to alcohol-associated liver disease,” Lee said. MedPage today. “We need more tools to be able to address this public health issue, and we wanted to see if labor shortages are an important area to focus on.”

These findings shed light on health care inequities and “could help professional societies, government agencies and payers focus on gaps in care,” said Andrew Talal, MD, of the University. from Buffalo, New York, who did not participate in the study. MedPage Today.

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

For this study, Lee and his colleagues looked at data from five federal registries — US Census, WONDER, Behavioral Risk Factor Surveillance System, National Survey of Substance Abuse Treatment Services, as well as the Health Resources and Services Administration — on deaths related to the ALD. between 2010 and 2019. Includes adults aged 25 and over.

For gastroenterologists, the national average geographic density was 4.6 per 100,000 people in 2019, while the ALD-related mortality rate was 85.6 per million people between 2010 and 2019 in the Continental States and the District of Columbia.

More than a five-fold difference was observed between states for 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 related deaths to ALD (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 the lowest ALD-related mortality, while the mountainous states had the lowest geographic density of gastroenterologists and the lowest ALD-related mortality. highest ALD-related mortality,” they noted.

Despite higher rates of harmful alcohol use and fibrosis, blacks had lower ALD-related mortality rates and lower overall ALD prevalence than whites and Hispanics.

The analysis was adjusted for demographics and other confounders.

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

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

The authors acknowledged the limitations of 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 writer for MedPage Today, covering gastroenterology and infectious diseases. She is based in Chicago.

Disclosures

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

Lee and his co-authors reported no conflicts of interest.

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