Portal hypertension is the build-up of blood pressure in the portal vein, which is a consequence of cirrhosis of the liver. The increased blood pressure causes portal fluid to be forced into alternate channels such as the peritoneal cavity and brain. At this point the only option for the patient is usually transplantation.
All data were obtained from the Nationwide Inpatient Sample, the largest database of hospital discharges in the U.S.
The rate of portosystemic shunt procedures was significantly less for African Americans (12.2 per 1000 hospitalizations) and Hispanics (17.1 per 1000 hospitalizations) than for whites (28.7 per 1000 hospitalizations), the investigators report. These differences persisted after adjustment for demographic, clinical, and insurance variables.
Despite similar rates of variceal bleeding, African American patients were 60 percent more likely than white patients to have endoscopy delayed more than 24 hours after admission, the results indicate.
Similarly, the researchers found, while the rate of liver transplantation was 61.3 per 1000 hospitalizations among whites, it was only 23.1 and 29.9 per 1000 hospitalizations among African Americans and Hispanics, respectively.
In-hospital mortality rates ranged from 7.2 percent for Hispanics to 9.4 percent for African Americans, with intermediate rates for whites (8.4 percent).
Having Medicare or Medicaid instead of private insurance also contributed to lower shunt procedure rates, delayed endoscopy, and lower liver transplantation rates, the report indicates. Uninsured patients had higher mortality rates than those with private insurance.
"Racial disparity in health care outcomes is an area that has been marginalized either because of the sensitivity or 'discomfort' to discuss it openly," Dr. Thuluvath said. "Nevertheless, until we have a scientific discussion, we are not going to make any progress, despite the good intentions of the Institute of Medicine that has set an ambitious goal to remove all disparities by 2020."
Perhaps, Dr. Thuluvath suggested, "hospitals should be federally mandated to report their outcomes among minorities, and institutional committees should be set up to identify and reduce these disparities."
Hepatology 2007;45:1282-1289.
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