Disparities in Unmet Needs in Indigenous and Non-Indigenous Australians with Cirrhosis: An Exploratory Study

Figures & data

Table 1 Patient’s Demographic and Clinical Characteristics at Recruitment According to Indigenous Status

Demographic and Clinical Characteristics		Indigenous	Non-Indigenous	p-value
		N=20	N=438
Age-group	18–64 years	15 (75.0%)	290 (66.2%)	0.48
	65+ years	5 (25.0%)	148 (33.8%)
Gender	Female	8 (40.0%)	125 (28.5%)	0.27
	Male	12 (60.0%)	313 (71.5%)
Marital status	Married/De Facto	8 (40.0%)	211 (48.2%)	0.47
	No partner	12 (60.0%)	227 (51.8%)
Live alone	No	13 (65.0%)	319 (72.8%)	0.44
	Yes	7 (35.0%)	119 (27.2%)
Education^Citation1	Junior High School or less	14 (73.7%)	181 (41.5%)	<0.01
	Senior High School of higher	5 (26.3%)	255 (58.5%)
Current employment	Employed	3 (15.0%)	98 (22.4%)	0.59
	Unemployed	17 (85.0%)	340 (77.6%)
Socioeconomic status^Citation2	Q1 most affluent/Q2/Q3	10 (50.0%)	293 (67.0%)	0.15
	Q4/Q5 most disadvantaged	10 (50.0%)	144 (33.0%)
Place of residence	Major city area	18 (90.0%)	377 (86.7%)	0.75
	Outside major city area	2 (10.0%)	58 (13.3%)
Primary liver disease aetiology	Alcohol	7 (35.0%)	165 (37.7%)	0.98
	HCV-HBV	7 (35.0%)	136 (31.1%)
	NAFLD/NASH	5 (25.0%)	104 (23.7%)
	Other	1 (5.0%)	33 (7.5%)
Co-factors	Alcohol	13 (65.0%)	291 (66.4%)	0.89
	NAFLD/NASH	11 (55.0%)	214 (48.9%)	0.59
Child-Pugh class^Citation3	A	14 (70.0%)	271 (64.4%)	0.70
	B	3 (15.0%)	97 (23.0%)
	C	3 (15.0%)	53 (12.6%)
Presence of complications of cirrhosis	Compensated	15 (75.0%)	291 (66.4%)	0.48
	Decompensated	5 (25.0%)	147 (33.6%)
	Portal hypertension	15 (75.0%)	292 (66.7%)	0.63
	Ascites	5 (25.0%)	114 (26.0%)	0.89
	Varices	7 (35.0%)	208 (47.5%)	0.27
Comorbidities	Diabetes	11 (55.0%)	182 (41.6%)	0.23
	Hypertension	8 (40.0%)	155 (35.4%)	0.67
	Dyslipidaemia	6 (30.0%)	100 (22.8%)	0.46
	Anxiety and/or depression	4 (20.0%)	106 (24.2%)	0.79
	Body Mass Index
	Normal/underweight	4 (20.0%)	132 (30.1%)	0.43
	Overweight	4 (20.0%)	112 (25.6%)
	Obese/morbidly obese	12 (60.0%)	194 (44.3%)

Notes: Bold value denote statistical significance at the p-value < 0.05 level; 1 information was missing for 3 patients; 2 information was missing 1 patient; 3 unable to calculate Child-Pugh score for 17 patients.

Table 2 Comparison of the Rate of Moderate-to-High Unmet Supportive Care Needs and the 20 Most Frequent Items Reported by Patients with Cirrhosis According to Indigenous Status

SNAC Subscales and Items		Indigenous	Non-Indigenous	p-value*	Subscale
		N=20	N=438
At least one moderate-to-high unmet need item (overall)		17 (85)	355 (81)	0.873
Rates of Moderate-to-High Unmet Need by Subscale		IRR (95% CI)	Reference	p-value**
Practical and physical needs		1.5 (1.22–1.83)	1.00	<0.001
Lifestyle changes		1.4 (0.77–2.67)	1.00	0.259
Psychosocial issues		1.7 (1.39–2.15)	1.00	<0.001
Information needs		1.1 (0.73–1.64)	1.00	0.677
Overall SNAC		1.5 (1.31–1.72)	1.00	<0.001
Rank^†	Items^‡	N (%)	N (%)	p-value***
1	Lack of energy	12 (60)	159 (36)	0.032	Practical and physical needs
2	Sleep poorly	11 (55)	157 (36)	0.082	Practical and physical needs
3	Have anxiety/stress	10 (50)	113 (26)	0.017	Psychosocial issues
4	Feel unwell	9 (45)	132 (30)	0.16	Practical and physical needs
5	Feel down/depressed	9 (45)	100 (23)	0.023	Psychosocial issues
6	Feel lonely	9 (45)	56 (13)	<0.001	Psychosocial issues
7	Worry about the worries of those close to you	9 (45)	97 (22)	0.018	Psychosocial issues
8	Difficulty with daily tasks	8 (40)	107 (24)	0.12	Practical and physical needs
9	Decreased ability to get around	8 (40)	83 (19)	0.021	Practical and physical needs
10	Make diet changes	8 (40)	87 (20)	0.030	Lifestyle changes
11	Fear of the unknown/uncertainty about the future	8 (40)	98 (22)	0.068	Psychosocial issues
12	Loss of appetite, nausea or vomiting	7 (35)	85 (19)	0.089	Practical and physical needs
13	Experienced side effects of treatment	7 (35)	75 (17)	0.041	Practical and physical needs
14	Feel frustrated	7 (35)	95 (21)	0.16	Psychosocial issues
15	Worry about your illness getting worse (liver cancer)	7 (35)	116 (27)	0.40	Psychosocial issues
16	Job performance decrease due to health	6 (30)	80 (18)	0.19	Psychosocial issues
17	Itchy skin	6 (30)	92 (21)	0.34	Practical and physical needs
18	Have lack of interest	6 (30)	101 (23)	0.47	Psychosocial issues
19	Fear being a burden	6 (30)	75 (17)	0.14	Psychosocial issues
20	Have tests/procedures explained	6 (30)	62 (14)	0.051	Information needs

Notes: Number and percentage (%); Bold values denote statistical significance at the p-value < 0.05 level; *logistic regression adjusted for Child-Pugh, age group, recruitment hospital, combined variable marital/live alone, place of residence, diabetes, and primary diagnosis; **Poisson regression adjusted for Child-Pugh, age group, recruitment hospital, combined variable marital/live alone, place of residence, diabetes, and primary diagnosis; ***Pearson chi-squared or Fisher’s exact test (for sparse tables); ^†Ranking based on the proportion of unmet needs in the Indigenous group. ^‡Simplified wording of items.

Abbreviations: CI, confidence interval; HR, hazard ratio; IRR, incidence rate ratio; IRSAD, Index of Relative Socioeconomic Advantage and Disadvantage; IQR, interquartile range; SNAC, Supportive Needs Assessment tool for Cirrhosis; SD, standard deviation.

Figure 1 Median SNAC scores according to Indigenous status.

Note: *p-value <0.005 (Wilcoxon rank-sum test).

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