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

BMC Gastroenterology

Research Article

Anuj Datta¹  Viktor E. Eysselein¹  Joel Alpern¹  Hal F. Yee²  Daniel Kim³  Daniel Eshtiaghpour³ 

[1] Department of Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA, USA;Department of Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA, USA;Department of Medicine, University of California, San Francisco, San Francisco, CA, USA;Department of Medicine, Harbor-UCLA Medical Center, Box 400, 1000 W. Carson St., 90509, Torrance, CA, USA;

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

DOI  :  10.1186/s12876-015-0318-y

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

来源: Springer

【 摘 要 】

BackgroundAutoimmune 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.MethodsWe 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.ResultsOverall 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.ConclusionsOutcomes 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】

CC BY   
© Kim et al. 2015