Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2022; 14(3): 559-569
Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.559
Standards of liver cirrhosis care in Central Australia
Sreecanth S Raja, Robert G Batey, Suzanne Edwards, Hein H Aung
Sreecanth S Raja, Department of Gastroenterology, Alice Springs Hospital, Alice Springs 0870, Northern Territory, Australia
Robert G Batey, Hein H Aung, Department of Medicine, Alice Springs Hospital, Alice Springs 0870, Northern Territory, Australia
Suzanne Edwards, Department of Statistician, School of Public Health, University of Adelaide, Adelaide 5000, South Australia, Australia
Author contributions: Raja SS and Batey RG designed the research study; Raja SS applied for local Ethical Approval and wrote the manuscript; Raja SS and Aung HH performed data collection; Raja SS, Edwards S and Batey RG analyzed the data; all authors have read and approve the final manuscript.
Institutional review board statement: Approval for this study was given by the Central Australian Health and Research Ethics Committee (Ref: CA-19-3415) and Alice Springs Hospital, Central Australian Health Service (Ref:EDOC2019/0172321).
Conflict-of-interest statement: The authors whose names are listed above certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. This project did not reveal any financial support from any organisation or institution.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at sreecanth.raja@sa.gov.au. Individual consent was not obtained but the presented data is de-identified without risk of identification.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sreecanth S Raja, BSc, MBBS, Doctor, Department of Gastroenterology, Alice Springs Hospital, Gap Road, Alice Springs 0870, Northern Territory, Australia. sreecanth.raja@sa.gov.au
Received: August 1, 2021
Peer-review started: August 1, 2021
First decision: September 29, 2021
Revised: October 4, 2021
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: March 27, 2022
Abstract
BACKGROUND

Liver cirrhosis and hepatocellular carcinoma (HCC) are highly prevalent in Australia’s Northern Territory. Contributing factors include high levels of alcohol consumption, viral hepatitis and metabolic syndrome. Rural Aboriginal residents form a significant proportion of the Central Australian population and present a challenge to traditional models of liver care. HCC surveillance and variceal screening are core components of liver cirrhosis management.

AIM

To assess participation in HCC and variceal surveillance programmes in a Central Australian liver cirrhosis patient cohort.

METHODS

Retrospective cohort study of patients with liver cirrhosis presenting to Alice Springs Hospital, Australia between January 1, 2012 and December 31, 2017. Demographic data, disease severity, attendance at hepatology clinics, participation in variceal and/or HCC surveillance programmes was recorded. Regression analyses were conducted to assess factors associated with two independent outcomes: Participation in HCC and variceal surveillance.

RESULTS

Of 193 patients were identified. 82 patients (42.4%) were female. 154 patients (80%) identified as Aboriginal. Median Model for End-stage Liver Disease Score at diagnosis was 11. Alcohol was the most common cause of cirrhosis. Aboriginal patients were younger than non-Aboriginal patients (48.4 years vs 59.9 years, P < 0.001). There were similar rates of excess alcohol intake (72.6% vs 66.7%, P = 0.468) and obesity (34.5% vs 38.4%, P = 0.573 across non-Aboriginal and Aboriginal cohorts. 20.1% of patients took part in HCC surveillance and 42.1% of patients completed variceal screening. Aboriginal patients were less likely to engage with either HCC surveillance (OR: 0.38, 95%CI: 0.16-0.9, P = 0.025) or undergo variceal screening (OR: 0.31, 95%CI: 0.14-0.65, P = 0.002).

CONCLUSION

HCC or variceal surveillance programmes had less uptake amongst Aboriginal patients. Greater emphasis needs to be placed on eliminating cultural obstacles to accessing hepatology services.

Keywords: Viral hepatitis, Cirrhosis, Hepatocellular carcinoma, Alcoholic liver disease, Central australia

Core Tip: Liver cirrhosis is prevalent in Australia’s Northern Territory. Liver disease is a contributor to the mortality gap between Aboriginal and non-Aboriginal Australians. 20.1% of patients included in our study participated in hepatocellular carcinoma surveillance and 42.1% of patients underwent screening endoscopy in a rural Australian centre. Aboriginal patients were less likely to engage with screening programs despite their predominance in our study cohort.