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The Hispanic Paradox in Patients with Liver Cirrhosis: Current Evidence from a Large Regional Retrospective Cohort Study



The Hispanic Paradox in Patients with Liver Cirrhosis: Current Evidence from a Large Regional Retrospective Cohort Study



Transplantation 2019



Despite lower socioeconomic status, Hispanics in the US paradoxically maintain equal or higher average survival rates compared to non-Hispanic Whites (NHW). We used multivariable Cox regression to assess whether this 'Hispanic paradox' applies to patients with liver cirrhosis using a retrospective cohort of 20,121 patients in a Chicago-wide electronic health record database. Our study population included, 3,279 (16%) Hispanics, 9,150 (45%) NHW, 4,432 (22%) African Americans, 529 (3%) Asians and 2,731 (14%) comprised other races/ethnic groups. Compared to Hispanics, NHW (HR 1.26 95% CI 1.16-1.37), African American (HR 1.26 95%CI 1.15-1.39) and other races/ethnic groups (HR 1.55 95%CI 1.40-1.71) had an increased risk of death despite adjustment for age, sex, insurance status, etiology of cirrhosis, and co-morbidities. On stratified analyses, a mortality advantage for Hispanics compared to NHW was seen for alcohol cirrhosis (HR for NHW 1.35 95%CI 1.19-1.52), Hepatitis B (HR for NHW 1.35 95%CI 0.98-1.87), Hepatitis C (HR for NHW 1.21 95%CI 1.06-1.38), and NASH (HR for NHW 1.14 95%CI 0.94-1.39). There was no advantage associated with Hispanic race over NHW in cases of hepatocellular carcinoma or cholestatic liver disease. Hispanic patients with cirrhosis experience a survival advantage over many other racial groups despite adjustment for multiple covariates.

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Accession: 066660464

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PMID: 30951016


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