Impact of Social Vulnerability on Future Risk of Metabolic Complications and Survival in Female Liver Transplant Recipients
Hiba Khan, Rehan Razzaq, Shreya Shah, Alexis Kim, Madison Nguyen, Shilpa Jasti, Ibrahim M. Siddiqui, Sheila Bullock, Vaishali PatelBackground.
Healthcare outcomes research has historically used males as the reference; however, such a comparison ignores key biological processes. Thus, the present study aimed to evaluate metabolic health in female liver transplant (LT) recipients, using female sex itself as the reference standard.
Methods.
Social vulnerability index (SVI) is a composite marker of external stressors to individual health, with a high SVI indicative of higher social vulnerability. Kaplan-Meier curves were constructed to determine the association between SVI and the likelihood of developing metabolic complications, including type 2 diabetes, obesity, hypertension, and all-cause mortality, 36 mo after LT in 252 adult females.
Results.
The baseline clinical profile was similar between patients with low (below median) and high (above median) SVI. Black females had a higher SVI than non-Hispanic White (hereafter, White) females. No difference in overall mortality or new-onset metabolic diseases was noted when patients were stratified based on high versus low SVI. Among patients with high SVI, Black females had a higher incidence of post-LT obesity and type 2 diabetes than White females. Survival was also lower in Black females with high SVI when compared with White females. When females with a low SVI were stratified according to ethnicity, no significant differences in survival or risk of metabolic conditions were noted.
Conclusions.
As defined by SVI, these data underscore the need to better understand healthcare disparities in LT patients to improve clinical outcomes.