The Impact of Socioeconomic Status on Cardiovascular Events and Mortality Following Liver Transplantation.

Abstract

Background In Australia and New Zealand, there are >250 liver transplantations (LT) performed annually with an associated 5-year mortality rate of 13%, with cardiovascular causes being the most common. Patients from low socioeconomic status (SES) backgrounds are overrepresented among patients with cirrhosis and liver failure. We sought to evaluate the impact of SES on major adverse cardiovascular events (MACE) and mortality following LT. Methods This retrospective cohort study assessed 150 adults undergoing LT between 2015-2018 in the Victorian Liver Transplant Unit, Melbourne. SES was evaluated through analysis of the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD), a validated scoring system incorporated in the Australian Cardiovascular Disease Risk Calculator. A lower decile indicates a greater degree of socioeconomic disadvantage. Results In total,150 patients underwent LT during the study period. Patients were followed up for a median of 6.6 years (IQR 5.9-7.5), with 28 deaths (18.7%) recorded. Sixty patients (40%) lived in areas below the IRSAD mean. No difference was noted in rates of MACE post-LT [11(18.3%) vs 20(22.2%), p=0.61], however low-IRSAD was associated with significantly higher rates of all-cause mortality [17(28.3%) vs 11(12.2%), p=0.014)] (Figure). Following multiple logistic regression controlling for cardiovascular risk factors including age, gender, hypertension and diabetes, an IRSAD score below the median remained a strong predictor of all-cause mortality (HR 4.43, 95% CI 1.23-15.96, p=0.023). Conclusion Socioeconomic disadvantage was not associated with MACE following LT, but was associated with a four-fold increased rate of all-cause mortality. These data reiterate the importance of ongoing equalisation measures in healthcare. [Figure Presented]Copyright � 2024