# The association of race with time to severe liver disease diagnoses

## TL;DR

Black patients had a longer time to severe liver disease diagnosis, possibly due to delayed detection or differences in disease progression.

## Contribution

This study identifies a racial disparity in the timing of severe liver disease diagnoses after adjusting for confounding factors.

## Key findings

- Black race was associated with a lower hazard of severe liver outcomes after adjusting for covariates.
- The study suggests delayed cirrhosis detection or differences in fibrosis progression by race.
- 3% of patients received a diagnosis code for a severe liver event during follow-up.

## Abstract

Evidence suggests that there are racial differences in liver fibrosis progression for patients with chronic liver disease (CLD). We examined the association of Black race with the time to diagnosis of severe liver disease outcomes in primary care patients.

We captured electronic health record data from a primary care clinic between 2012−2021. Race, categorized as Black and non-Black, was the primary exposure. The outcome was the occurrence of a severe liver event identified by ICD-9/10 codes, defined as a composite of cirrhosis, complications of cirrhosis, hepatocellular carcinoma, and liver transplantation. Cox regression models evaluated the association of Black race with the time to severe liver outcomes while adjusting for potentially confounding covariates.

The cohort included 20,828 patients of whom 43% identified as Black and 14% had a known diagnosis of CLD during follow-up. Of all patients, 3% received a diagnosis code for a severe liver event. In an unadjusted Cox regression model, Black race was associated with an increased hazard of a severe liver event (HR 1.32; 95%CI 0.98–1.34), but after adjusting for known CLD, baseline fibrosis risk, demographic, and comorbidity variables, Black race was associated with a significantly lower hazard of a severe liver outcome (HR 0.68; 95%CI 0.57–0.81).

After adjusting for potentially confounding covariates, Black race was associated with a longer time to a severe liver disease diagnosis. This finding raises the possibilities of delayed cirrhosis detection or differences in liver fibrosis progression by racial identifiers.