University of North Carolina, Department of Medicine, Division of Gastroenterology and Hepatology. firstname.lastname@example.org.
Background: Prior studies have examined the impacts of demographic factors on liver transplant outcomes. These factors may be surrogate markers for access to medical care. We investigated physician density in referred patients' hospital service areas as a factor in patients' probability to receive a liver transplant. Methods: We performed a retrospective review of patients referred for liver transplantation from 2002 through 2010. Data on physician density was obtained from the Dartmouth Atlas. The primary outcome was receipt of a liver transplant. Cox Hazard Analysis was used to control for various demographic and medical covariates. Results: 1485 adult patients were considered for liver transplant over the time period. Factors that influenced the hazard of receiving a liver transplant were MELD score at referral [HR 1.11 (1.09 - 1.14) per point], secondary diagnosis of hepatocellular carcinoma [HR 2.76 (1.76 - 4.20)], blood group AB [OR 2.98 (1.52 - 5.87), referent A], the type of insurance [Medicare OR 0.36 (0.14 - 0.89); referent commercial insurance], and the number of gastroenterologists in a hospital service area [OR 1.12 (1.01 - 1.25) per increase in each gastroenterologist per 100,000 population]. Age, race, sex, distance to transplant center, or residence in a rural community did not influence the hazard to receive a liver transplant. Conclusions: The hazard of receiving a liver transplant is influenced by diagnosis, MELD, and insurance status; in addition patients were 12% more likely to receive a transplant for each unit increase in gastroenterologists per 100,000 population in their local hospital service area. Local access to gastroenterology subspecialty care is an important factor in receiving a liver transplant.