A retrospective cohort study of socioeconomic deprivation and post-liver transplant survival in adults.

The Area Deprivation Index is a granular measure of neighborhood socioeconomic deprivation. The relationship between neighborhood socioeconomic deprivation and recipient survival following liver transplantation (LT) is unclear. To investigate this, the authors performed a retrospective cohort study of adults who underwent LT at the University of Washington Medical Center from January 1, 2004, to December 31, 2020. The primary exposure was a degree of neighborhood socioeconomic deprivation as determined by the Area Deprivation Index score. The primary outcome was posttransplant recipient mortality. In a multivariable Cox proportional analysis, LT recipients from high-deprivation areas had a higher risk of mortality than those from low-deprivation areas (HR: 1.81; 95% CI: 1.03-3.18, p =0.04). Notably, the difference in mortality between area deprivation groups did not become statistically significant until 6 years after transplantation. In summary, LT recipients experiencing high socioeconomic deprivation tended to have worse posttransplant survival. Further research is needed to elucidate the extent to which neighborhood socioeconomic deprivation contributes to mortality risk and identify effective measures to improve survival in more socioeconomically disadvantaged LT recipients.

Identifying Liver Transplant Candidates at Risk of Wait List Removal Due to Nonadherence Using a Quality-of-Life Survey: A Competing Risk Analysis.

OBJECTIVES: We investigated whether the Liver Disease Health-Related Quality of Life Short Form or the Area Deprivation Index could be used to help identify liver transplant candidates at risk of delisting due to nonadherence. MATERIALS AND METHODS: We conducted a retrospective study of 358 adults (≥18 years old) listed for liver transplant at the University of Washington Medical Center from September 1, 2012, to August 30, 2017, who completed the Liver Disease Health-Related Quality of Life Short Form prior to listing. Wait list removal because of substance use or lack of attendance to clinical appointments was prospectively determined by a multidisciplinary transplant committee. A competing risk analysis was used to estimate risk of delisting for nonadherence. RESULTS: Among 358 liver transplant candidates, delisting occurred in 23 patients (6.4%) for nonadherence, 205 (57.3%) for transplant, 79 (22.1%) because of death or too sick, and 51 (14.2%) for other reasons. In the multivariable competing risk analysis, Liver Disease Health-Related Quality of Life Short Form responses indicating "poor memory" (subdistribution hazard ratio: 3.53; 95% CI, 1.49-8.36; P = .004) and "poor future outlook" (subdistribution hazard ratio: 2.94; 95% CI, 1.07-8.07; P = .03) were associated with higher risk of delisting for nonadherence. Female sex (subdistribution hazard ratio: 0.31; 95% CI, 0.10-0.93; P = .04) and previous abdominal surgery (subdistribution hazard ratio: 0.36; 95% CI, 0.14-0.92; P = .03) were associated with lower risk of delisting for nonadherence. The Area Deprivation Index was not associated with wait list removal. CONCLUSIONS: Liver Disease Health-Related Quality of Life Short Form responses indicating "poor memory" and "poor future outlook" were associated with increased risk of wait list removal due to nonadherence. Proactively identifying patients at high risk of nonadherence may help transplant programs better direct resources toward helping patients improve adherence and avoid delisting.

Criminal Use of Assault Weapons and High-Capacity Semiautomatic Firearms: an Updated Examination of Local and National Sources.

Policies restricting semiautomatic assault weapons and large-capacity ammunition magazines are intended to reduce gunshot victimizations by limiting the stock of semiautomatic firearms with large ammunition capacities and other military-style features conducive to criminal use. The federal government banned such weaponry from 1994 to 2004, and a few states currently impose similar restrictions. Recent debates concerning these weapons have highlighted their use in mass shootings, but there has been little examination of their use in gun crime more generally since the expiration of the federal ban. This study investigates current levels of criminal activity with assault weapons and other high-capacity semiautomatics in the USA using several local and national data sources including the following: (1) guns recovered by police in ten large cities, (2) guns reported by police to federal authorities for investigative tracing, (3) guns used in murders of police, and (4) guns used in mass murders. Results suggest assault weapons (primarily assault-type rifles) account for 2-12% of guns used in crime in general (most estimates suggest less than 7%) and 13-16% of guns used in murders of police. Assault weapons and other high-capacity semiautomatics together generally account for 22 to 36% of crime guns, with some estimates upwards of 40% for cases involving serious violence including murders of police. Assault weapons and other high-capacity semiautomatics appear to be used in a higher share of firearm mass murders (up to 57% in total), though data on this issue are very limited. Trend analyses also indicate that high-capacity semiautomatics have grown from 33 to 112% as a share of crime guns since the expiration of the federal ban-a trend that has coincided with recent growth in shootings nationwide. Further research seems warranted on how these weapons affect injuries and deaths from gun violence and how their regulation may impact public health.