For a study, researchers sought to investigate the links between residing in a primary care deficit region and graft failure/death in children after a liver transplant.
It was observational research of all pediatric patients (aged 19 years) who got a liver transplant in the United States between January 1, 2005, and December 31, 2015, with a follow-up period through January 2019 (N=5,964). One hundred ninety-five individuals were omitted because their home ZIP code could not match their primary care shortage area status. The primary endpoint was a composite of graft failure or death. The correlations between health professional shortage area (HPSA) and graft failure/death were modeled using Cox proportional hazards.
Children who lived in HPSAs had lower projected graft survival rates at 10 years than those who did not (76% vs. 80%; P<.001). In univariable analysis, residency in an HPSA was associated with a 22% increased risk of graft failure/death compared to non-residents in an HPSA (hazard ratio [HR], 1.22; 95% CI, 1.09-1.36; P<.001). When compared to non-HPSA children, Black children had a 67% greater risk of graft failure/death (HR, 1.67; 95% CI, 1.29 to 2.16; P=.006); the effect of HPSA status was less significant for White children (HR, 1.11; 95% CI, 0.98-1.27; P=.10).
Children living in locations with a paucity of primary care are at a higher risk of graft failure and mortality following a liver transplant, and this danger is more acute for Black children. Future research on how residing in these areas relates to poor outcomes may help teams to reduce this risk for all children with chronic illnesses.
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