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Abstract Details
The road to pandemic recovery: Tracking COVID-19's impact on cirrhosis care and outcomes among 111,558 Veterans
Hepatology. 2023 Jun 1;77(6):2016-2029. doi: 10.1097/HEP.0000000000000306.Epub 2023 Jan 30.
1Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
2Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
3Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California, USA.
4Pharmacy Benefits Management, Veterans Integrated Service Network 20, Vancouver, Washington, USA.
5Pharmacy Benefits Management, Veterans Integrated Service Network 8, Bay Pines, Florida, USA.
6Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA.
7VA Richmond Health Care System, Richmond, Virginia, USA.
8Gastroenterology and Hepatology, VA Portland Health Care System, Portland, Oregon, USA.
9VA Puget Sound Health Care System, Seattle, Washington, USA.
10Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA.
11Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Abstract
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.