Distinct effects of racial and socioeconomic disparities on biliary atresia diagnosis and outcome

Abstract Objectives To identify and distinguish between racial and socioeconomic disparities in age at hepatology care, diagnosis, access to surgical therapy, and liver transplant‐free survival in patients with biliary atresia (BA). Methods Single‐center retrospective cohort study of 69 BA patients from 2010 to 2021. Patients were grouped into White and non‐White cohorts. The socioeconomic milieu was analyzed utilizing neighborhood deprivation index, a census tract‐based calculation of six socioeconomic variables. The primary outcomes of this study were timing of the first hepatology encounter, surgical treatment with hepatic portoenterostomy (HPE), and survival with native liver (SNL) at 2 years. Results Patients were 55% male and 72% White. White patients were referred at a median of 34 days (interquartile range IQR: 17–65) vs. 67 days (IQR: 42–133; p = 0.001) in non‐White patients. White infants were more likely to undergo HPE (42/50 patients; 84%) compared to non‐White (10/19; 53%), odds ratio (OR) 4.73 (95% confidence interval: 1.46–15.31; p = 0.01). Independent of race, patients exposed to increased neighborhood‐level deprivation were less likely to receive HPE (OR: 0.49, p = 0.04) and achieve SNL (OR: 0.54, p = 0.02). Conclusions Racial and socioeconomic disparities are independently associated with timely BA diagnosis, access to surgical treatment, and transplant‐free survival. Public health approaches to improve screening for pathologic jaundice in infants of diverse racial backgrounds and to test and implement interventions for socioeconomically at‐risk families are needed.