Access to primary care is associated with better autoimmune hepatitis outcomes in an urban county hospital

BMC Gastroenterology

Hal F. Yee³  Viktor E. Eysselein²  Anuj Datta²  Joel Alpern²  Daniel Eshtiaghpour¹  Daniel Kim¹ 

[1] Department of Medicine, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance 90509, CA, USA;Department of Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA, USA;Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

关键词: Hispanic;    Safety-net;    County;    Autoimmune hepatitis;   

Others  :  1224266
DOI  :  10.1186/s12876-015-0318-y

 received in 2015-02-16, accepted in 2015-07-16,  发布年份 2015

【 摘 要 】

Background

Autoimmune hepatitis causes chronic hepatitis and often leads to cirrhosis and death without treatment. We wanted to see if having access to primary care or insurance prior to diagnosis is associated with better outcomes for patients in an urban, public hospital with mostly socioeconomically disadvantaged Hispanic patients.

Methods

We did a retrospective study at our institution. Kaplan Meier survival analysis was done looking at transplant-free overall survival for patients diagnosed at our institution. The log-rank test was done to compare survival between patients with and without prior access to primary care, and between patients with and without insurance at diagnosis.

Results

Overall 5- and 10-year transplant-free overall survival was 91 % (95 % CI, 83-100 %) and 75 % (95 % CI, 50-99 %), respectively. Patients with primary care prior to diagnosis had significantly better transplant-free overall survival than those without (log rank test p = 0.019). Patients with primary care also had better clinical markers at diagnosis. Having insurance at diagnosis was not associated with better outcomes.

Conclusions

Outcomes of autoimmune hepatitis are poor in our setting but access to primary care prior to diagnosis was associated with better outcomes. This is likely due to the important role that primary care plays in detecting disease and initiating treatment earlier. With the expansion of access to healthcare that the Affordable Care Act provides, future patients are likely to do better with even rare diseases like autoimmune hepatitis.

【 授权许可】

   
2015 Kim et al.

【 图 表 】

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