Skip to main content
Grant Details

Grant Number: 5R01CA256977-02 Interpret this number
Primary Investigator: Kanwal, Fasiha
Organization: Baylor College Of Medicine
Project Title: Multi-Level Evaluation of Racial/Ethnic Disparities in Liver Disease Outcomes
Fiscal Year: 2022


ABSTRACT Cirrhosis – the end-stage result of chronic liver disease – is a condition with high morbidity and mortality that is becoming increasingly common. Nearly half of all patients with cirrhosis develop hepatic decompensation including hepatocellular cancer (HCC), with frequent hospitalization within 5 years of cirrhosis diagnosis. Several studies show that these cirrhosis complications disproportionately affect racial/ethnic minorities and persons of low socioeconomic status (SES). But fundamental questions remain unanswered given that only few studies investigated the mechanisms that underlie these disparities. The research proposed here aims to provide actionable information on what to target to reduce cirrhosis prognosis disparities. We will conduct a comprehensive evaluation of multilevel factors hypothesized to play important roles in causing racial/ethnic and SES disparities in three key measures of cirrhosis prognosis: a) hepatic decompensation, including HCC, b) liver-related hospitalization, and c) overall survival. We propose a large, multicenter, racially and socio-economically diverse cohort study of cirrhosis patients enrolled from four healthcare systems; the project will combine information from existing clinical databases, genomic data, and geospatial analyses with patient- and clinician- surveys to provide unparalleled information about the role of individual, interpersonal, and community-level factors in the racial/ethnic and SES disparities in cirrhosis prognosis. The proposed cohort includes representative groups from all racial/ethnic (blacks, Hispanics, Asian-Pacific Islanders) and SES groups. It also spans the full spectrum of disease severity (from compensated to advanced decompensated disease), rather than focusing on a few groups. We will uncover the relative contributions of established (hepatitis C virus, hepatitis B virus) and emerging (obesity, diabetes) etiological risk factors as well as risk behaviors (alcohol use) to cirrhosis prognosis disparities. We will also characterize pathways that contribute to cirrhosis disparities among the high order determinants at the individual (e.g., medical mistrust), interpersonal (e.g., bias), and community (e.g., access to transportation) levels either directly or by affecting etiological or behavioral risk factors. Identification of these root cause mechanisms will identify actionable targets for intervention and policy change. We will also examine a set of genetic single nucleotide polymorphisms using stored sera in a subset of the cohort to understand the role of genetic differences, if any, in explaining racial/ethnic disparities.


Longitudinal Associations of Risk Factors and Hepatocellular Carcinoma in Patients With Cured Hepatitis C Virus Infection.
Authors: Kramer J.R. , Cao Y. , Li L. , Smith D. , Chhatwal J. , El-Serag H.B. , Kanwal F. .
Source: The American journal of gastroenterology, 2022-11-01; 117(11), p. 1834-1844.
EPub date: 2022-08-23.
PMID: 36327437
Related Citations

Synergistic Associations of PNPLA3 I148M Variant, Alcohol Intake, and Obesity With Risk of Cirrhosis, Hepatocellular Carcinoma, and Mortality.
Authors: Kim H.S. , Xiao X. , Byun J. , Jun G. , DeSantis S.M. , Chen H. , Thrift A.P. , El-Serag H.B. , Kanwal F. , Amos C.I. .
Source: JAMA network open, 2022-10-03; 5(10), p. e2234221.
EPub date: 2022-10-03.
PMID: 36190732
Related Citations

Racial, Ethnic, and Socioeconomic Disparities in Treatment Delay Among Patients With Hepatocellular Carcinoma in the United States.
Authors: Wagle N.S. , Park S. , Washburn D. , Ohsfeldt R.L. , Rich N.E. , Singal A.G. , Kum H.C. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2022-08-04; , .
EPub date: 2022-08-04.
PMID: 35933076
Related Citations

Contemporary Changes in Etiology for Hepatocellular Carcinoma in Liver Transplantation.
Authors: Goff C. , Shaikh A. , Goli K. , El-Serag H.B. , Kanwal F. , Cholankeril G. , Collaborators from Liver Cancer Investigator Working Group .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2022-07-20; , .
EPub date: 2022-07-20.
PMID: 35870770
Related Citations

Barriers to Surveillance for Hepatocellular Carcinoma in a Multicenter Cohort.
Authors: Parikh N.D. , Tayob N. , Al-Jarrah T. , Kramer J. , Melcher J. , Smith D. , Marquardt P. , Liu P.H. , Tang R. , Kanwal F. , et al. .
Source: JAMA network open, 2022-07-01; 5(7), p. e2223504.
EPub date: 2022-07-01.
PMID: 35867057
Related Citations

Long-term outcomes and trends in liver transplantation for hereditary hemochromatosis in the United States.
Authors: Lymberopoulos P. , Prakash S. , Shaikh A. , Bhatnagar A. , Allam A.K. , Goli K. , Goss J.A. , Kanwal F. , Rana A. , Kowdley K.V. , et al. .
Source: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2022-06-30; , .
EPub date: 2022-06-30.
PMID: 35770428
Related Citations

Significant improvements, but consistent disparities in survival for African Americans after liver transplantation.
Authors: Keeling S.S. , McDonald M.F. , Anand A. , Handing G.E. , Prather L.L. , Christmann C.R. , Jalal P.K. , Kanwal F. , Cholankeril G. , Goss J.A. , et al. .
Source: Clinical transplantation, 2022 Jun; 36(6), p. e14646.
EPub date: 2022-03-25.
PMID: 35304775
Related Citations

Effect of diabetes medications and glycemic control on risk of hepatocellular cancer in patients with nonalcoholic fatty liver disease.
Authors: Kramer J.R. , Natarajan Y. , Dai J. , Yu X. , Li L. , El-Serag H.B. , Kanwal F. .
Source: Hepatology (Baltimore, Md.), 2022 Jun; 75(6), p. 1420-1428.
EPub date: 2021-12-19.
PMID: 34779535
Related Citations

Systematic review with meta-analysis: incidence of variceal hemorrhage in patients with cirrhosis undergoing transesophageal echocardiography.
Authors: Odewole M. , Sen A. , Okoruwa E. , Lieber S.R. , Cotter T.G. , Nguyen A.D. , Mufti A. , Singal A.G. , Rich N.E. .
Source: Alimentary pharmacology & therapeutics, 2022 May; 55(9), p. 1088-1098.
EPub date: 2022-03-28.
PMID: 35343613
Related Citations

Comparable Survival for Hepatitis C-Related Hepatocellular Carcinoma After Liver Transplantation Irrespective of Viremic Status.
Authors: Lymberopoulos P. , Shaikh A. , Rich N.E. , Benhammou J.N. , Kanwal F. , Cholankeril G. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2022-03-26; , .
EPub date: 2022-03-26.
PMID: 35346850
Related Citations

Clinical Characteristics and Outcomes of Nonalcoholic Fatty Liver Disease-Associated Hepatocellular Carcinoma in the United States.
Authors: Karim M.A. , Singal A.G. , Kum H.C. , Lee Y.T. , Park S. , Rich N.E. , Noureddin M. , Yang J.D. .
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2022-03-17; , .
EPub date: 2022-03-17.
PMID: 35307595
Related Citations

NAFLD and HCC: Time to Bridge the Gap.
Authors: Cholankeril G. , Kanwal F. .
Source: Hepatology (Baltimore, Md.), 2021 Nov; 74(5), p. 2336-2338.
EPub date: 2021-08-30.
PMID: 34164841
Related Citations

Mediation model with a categorical exposure and a censored mediator with application to a genetic study.
Authors: Wang J. , Ning J. , Shete S. .
Source: PloS one, 2021; 16(10), p. e0257628.
EPub date: 2021-10-12.
PMID: 34637449
Related Citations

Back to Top