The road to pandemic recovery: Tracking COVID-19's impact on cirrhosis care and outcomes among 111,558 Veterans

Background & Aims: This study aimed to evaluate quarterly trends in process and health outcomes among Veterans with cirrhosis and assess the factors associated with cirrhosis outcomes before and during the COVID-19 pandemic. Approach & Results: US Veterans with cirrhosis were identified usin...

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Vydáno v:Hepatology (Baltimore, Md.) Ročník 77; číslo 6; s. 2016 - 2029
Hlavní autoři: Adejumo, Adeyinka C., Yakovchenko, Vera, Morgan, Timothy R., Spoutz, Patrick, Chia, Linda, Bajaj, Jasmohan S., Chang, Michael F., Dominitz, Jason A., Rogal, Shari S.
Médium: Journal Article
Jazyk:angličtina
Vydáno: Hagerstown, MD Lippincott Williams & Wilkins 01.06.2023
Témata:
Carcinoma, Hepatocellular - epidemiology
Carcinoma, Hepatocellular - therapy
COVID-19 - complications
COVID-19 - epidemiology
End Stage Liver Disease - complications
Esophageal and Gastric Varices - complications
Esophageal and Gastric Varices - etiology
Fibrosis
Gastrointestinal Hemorrhage - epidemiology
Humans
Liver Cirrhosis - complications
Liver Cirrhosis - epidemiology
Liver Cirrhosis - therapy
Liver Neoplasms - diagnosis
Liver Neoplasms - epidemiology
Liver Neoplasms - therapy
Pandemics
Retrospective Studies
Severity of Illness Index
Veterans
ISSN:0270-9139, 1527-3350, 1527-3350
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Shrnutí:Background & Aims: This study aimed to evaluate quarterly trends in process and health outcomes among Veterans with cirrhosis and assess the factors associated with cirrhosis outcomes before and during the COVID-19 pandemic. Approach & Results: US Veterans with cirrhosis were identified using the Veterans Health Administration Corporate Data Warehouse. Quarterly measures were evaluated from September 30, 2018, through March 31, 2022, including twice yearly screening for hepatocellular carcinoma (HCC-6), new HCC, surveillance for or treatment of esophageal varices, variceal bleeding, all-cause hospitalization, and mortality. Joinpoint analyses were used to assess the changes in trends over time. Logistic regression models were used to identify the demographic and medical factors associated with each outcome over time. Among 111,558 Veterans with cirrhosis with a mean Model for End-stage Liver Disease-Sodium of 11±5, rates of HCC-6 sharply declined from a prepandemic peak of 41%, to a nadir of 28%, and rebounded to 36% by March 2022. All-cause mortality did not significantly change over the pandemic, but new HCC diagnosis, EVST, variceal bleeding, and all-cause hospitalization significantly declined over follow-up. Quarterly HCC diagnosis declined from 0.49% to 0.38%, EVST from 50% to 41%, variceal bleeding from 0.15% to 0.11%, and hospitalization from 9% to 5%. Rurality became newly, significantly associated with nonscreening over the pandemic (aOR for HCC−6=0.80, 95% CI 0.74 to 0.86; aOR for EVST=0.95, 95% CI 0.90 to 0.997). Conclusions: The pandemic continues to impact cirrhosis care. Identifying populations at the highest risk of care disruptions may help to address ongoing areas of need.
Bibliografie:Abbreviations: EVST: esophageal variceal surveillance or treatment; FY: fiscal year; HCC-6: six-month screening for HCC; MELD-Na: Model for End-stage Liver Disease-Sodium; Q: quarter; QPC: quarterly percentage change; VA: Veterans Health Administration. Correspondence Shari S. Rogal, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA 15240-1001. Email: rogalss@upmc.edu, shari.rogal@va.gov
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ISSN:0270-9139
1527-3350
1527-3350
DOI:10.1097/HEP.0000000000000306