Black Patients With Cirrhosis Have Higher Mortality and Lower Transplant Rates: Results From a Metropolitan Cohort Study.

BACKGROUND AND AIMS: Estimates of racial disparity in cirrhosis have been limited by lack of large-scale, longitudinal data, which track patients from diagnosis to death and/or transplant. APPROACH AND RESULTS: We analyzed a large, metropolitan, population-based electronic health record data set from seven large health systems linked to the state death registry and the national transplant database. Multivariate competing risk analyses, adjusted for sex, age, insurance status, Elixhauser score, etiology of cirrhosis, HCC, portal hypertensive complication, and Model for End-Stage Liver Disease-Sodium (MELD-Na), examined the relationship between race, transplant, and cause of death as defined by blinded death certificate review. During the study period, 11,277 patients met inclusion criteria, of whom 2,498 (22.2%) identified as Black. Compared to White patients, Black patients had similar age, sex, MELD-Na, and proportion of alcohol-associated liver disease, but higher comorbidity burden, lower rates of private insurance, and lower rates of portal hypertensive complications. Compared to White patients, Black patients had the highest rate all-cause mortality and non-liver-related death and were less likely to be listed or transplanted (P < 0.001 for all). In multivariate competing risk analysis, Black patients had a 26% increased hazard of liver-related death (subdistribution HR, 1.26; 95% CI, [1.15-1.38]; P < 0.001). CONCLUSIONS: Black patients with cirrhosis have discordant outcomes. Further research is needed to determine how to address these real disparities in the field of hepatology.

A Direct Method for Determining Toricity Ratios of Toric Intraocular Lens Calculators.

This study develops a method to determine toricity ratios used by arbitrary toric intraocular lens calculators. Access to this information allows for the improvement of refractive results. We derive the Sayegh-Gabra formula, which uses input and output parameters in a toric calculator to extract toricity ratios that are typically not disclosed. We illustrate the method on a number of commercial calculators. For each calculator, high, average, and low axial length values are crossed with high, average, and low mean corneal power values to generate a 3 × 3 matrix. A toricity ratio is generated for each axial length and mean corneal power pair. We thus identify several toric lens manufacturers' calculators that use a constant toricity ratio, often 1.46. Some others use a variable ratio centered at 1.46, but varying as axial length and mean K increases over a range of values corresponding to physiological myopia and hyperopia. There is an emerging trend away from constant toricity ratios. Using our methodology, it is possible to extract the toricity ratio used by specific calculators/manufacturers, distinguish those using constant versus variable toricity ratios, and use this information to improve surgical outcomes by refining current and future toric intraocular lens calculators.