Access to Gastroenterology Care Associated With Liver Disease Mortality

Investigators at the University of Southern California found that the geographic density of gastroenterologists and mortality from alcohol-associated liver disease (ALD) are associated, according to a study recently published online by Clinical Gastroenterology and Hepatology.

ALD is the leading cause of liver-related mortality and has been on the rise, the researchers noted.

The team gathered state-level demographics and national data for adults aged 25 years old and above, along with mortality estimates for 2010-2019 via federally maintained registries. They used multivariable linear regression to determine whether an association existed between state-level geographic density of gastroenterologists and ALD-related mortality. This analysis was adjusted for age, sex, race/ethnicity, and other potential confounders.

The national mean geographic density of gastroenterologists for 50 states and the District of Columbia was 4.6 per 100,000 population; the annual mortality rate for ALD was 85.6 per 1,000,000 population. The study showed a greater than 5-fold difference in geographic density of gastroenterologists and ALD-related mortality across the US.

“In multivariable analysis, the geographic density of gastroenterologists was significantly associated with lower ALD-related mortality (9.0 [95%CI 1.3-16.7] fewer ALD-related deaths per 1,000,000 population for each additional gastroenterologist per 100,000 population),” the investigators reported. The association appeared to peak at a threshold of ≥7.5 gastroenterologists per 100,000 population.”

The authors estimated that differences in the geographic density of gastroenterologists across the US may potentially represent 40% of national ALD-related mortality. Exploratory analyses determined that the results were not confounded by generalized subspecialty care, transplant access, alcohol taxation, and substance use or mental health services.

“State-level geographic density of gastroenterologists is associated with lower ALD-related mortality,” the investigators wrote. “These results may inform medical societies and health policymakers to address anticipated workforce gaps to address the growing epidemic of ALD.”

—Rebecca Mashaw

References:
Lee BP, Dodge JL, Terrault NA. Geographic density of gastroenterologists is associated with decreased mortality from alcohol-associated liver disease. Clin Gastroenterol Hepatol. Published online August 4, 2022  DOI: https://doi.org/10.1016/j.cgh.2022.07.020