2023 年 14 巻 1 号 p. 1-12
Background: Alcoholic liver cirrhosis is a life-threatening condition, especially in patients who are unable to reduce their alcohol use. Alcohol abuse is closely linked to low socioeconomic status and social marginalization. In Japan, public assistance (PA) or Seikatsu-hogo ensures medical care for low-income populations. This study aimed to investigate the potential excess mortality among patients with alcoholic cirrhosis who were recipients of PA.
Methods: Patients diagnosed with alcoholic liver cirrhosis at a community hospital between 2006 and 2017 were included in this retrospective study. Baseline demographics and mortality data were extracted from the electronic health records. Cirrhosis severity at baseline was measured using the mean model for end-stage liver disease (MELD) and albumin-bilirubin (ALBI) scores. The primary outcome was the survival probability obtained using the Cox proportional hazards regression analysis.
Results: A total of 244 participants were included, of which 62 were PA recipients. Baseline cirrhosis severity scores did not differ between the PA group and non-PA groups. The overall mortality rates were 48.4% and 31.9% for PA and non-PA recipients, respectively (p=0.002). In the Cox regression model adjusted for age, ALBI score, HCV infection, and presence or absence of a designated key family contact, the hazard ratio for PA status was 1.75 [95%CI 1.03-2.98, p=0.039].
Conclusions: Being a PA recipient is a poor prognostic factor for overall mortality in patients with alcoholic liver cirrhosis after adjusting for age, cirrhosis severity, and social support.
