Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.559
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
Northern Territory (NT), Australia has high rates of liver cirrhosis and hepatocellular carcinoma (HCC) as a consequence of harmful alcohol use, viral hepatitis and metabolic syndrome. Aboriginal persons constitute a significant proportion of the population in the Central Australian region of NT. Several challenges are faced in providing culturally appropriate liver care to the diverse Central Australian population.
Liver disease has been identified as a significant contributor to the well cited mortality gap between Aboriginal and non-Aboriginal Australians. Central Australia is unique within Australia given its high proportion of Aboriginal residents. Formal adherence with HCC or variceal screening programmes have not been specifically assessed in Central Australia.
Our first research objectives involves description of the baseline charachteristics of inpatients presenting to a Central Australian hospital. Our second research objective involves assessment of adherence with HCC surveillance as well as analysis of the factors associated with participation. Our third research objective involves assessment of adherence with HCC surveillance as well as analysis of the factors associated with participation.
Our study methodology involved performing a retrospective cohort study. All idenitified patients presenting to inpatient departments at Alice Springs Hospital, NT, Australia between 2012 to 2017 were included in the study. We collected data including demographics, disease causation and severity (Child-Pugh Score), referral to hepatology clinics and adherence with variceal and/or HCC surveillance programmes. Regression analyses were conducted to assess factors associated with two independent outcomes: Adherence with HCC and variceal surveillance.
Aboriginal persons were over-represented and made up 80% of the study cohort. Aboriginal patients were younger and presented with more severe disease than non-Aboriginal counterparts. Overall 20.1% of our study cohort participated in HCC surveillance while 42.1% of patients underwent variceal screening. Aboriginal ethnicity was inversely associated with participation in HCC surveillance.
This is the first study examining adherence with standards of liver cirrhosis care in Central Australia. Liver cirrhosis in Central Australia disproportionately affects Aboriginal communities as a corollary of adverse metabolic profiles, hazardous alcohol intake and viral hepatitis. The current centralised model of cirrhosis care does not adequately meet the need of Aboriginal Central Australians. Our study demonstrates the pressing need for interventions to improve participation of Aboriginal patients with cirrhosis in HCC screening in order to ameliorate the morbidity and mortality associated with delayed diagnosis. Language, geographical and cultural factors are important prisms through which to examine low participation rates among Aboriginal patients in Central Australia. This is compounded by limited utilisation of valuable primary care links. Correspondingly, interventions aimed at closing the gap in liver related health outcomes between Aboriginal and non-Aboriginal patients need to focus on addressing these factors.
Future research should focus on piloting alternative models of cirrhosis care for Aboriginal patients with liver cirrhosis in Central Australia. Alternative care models should focus on expanding provision of telehealth services, enhancing utilisation of primary health care links and culturally tailoring care.