{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:23:16Z","timestamp":1793413396100,"version":"4.5.0"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Severe alcohol-associated hepatitis (sAH) is a leading indication for liver transplant (LT). However, access to LT begins with referral, a step that may not have been previously characterized using prospective multicenter data with detailed measures of social determinants of health.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association of clinical severity and neighborhood disadvantage with referral, wait-listing, transplant, and short-term mortality in patients hospitalized with sAH.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This prospective multicenter cohort study was a secondary analysis of the Alcohol-Associated Hepatitis Network observational cohort. It included patients hospitalized with sAH (Model for End-Stage Liver Disease [MELD] &amp;gt;20) across 5 US transplant centers from May 6, 2019, to November 8, 2023. Clinical, demographic, and social determinants of health data, including the Area Deprivation Index (ADI), were collected prospectively.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Clinical severity (MELD score) and neighborhood-level disadvantage (ADI).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were referral for LT evaluation, wait-listing, and receipt of LT, and the secondary outcome was 180-day mortality. Logistic regression and generalized additive models were used to evaluate independent and interactive associations of MELD and ADI with outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The cohort included 325 patients (mean [SD] age, 44.8 [10.2] years; 197 males [60.6%]). The mean (SD) MELD score was 29.2 (7.6), and the mean (SD) ADI was 56.2 (24.4). Only 120 patients (36.9%) were referred for LT. In multivariable analysis, higher MELD scores were associated with lower referral odds (odds ratio, 1.13 [95% CI, 1.07-1.18];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). ADI was not associated with referral odds (odds ratio, 0.99 [95% CI, 0.97-1.00];\n P<\/jats:italic>\n \u2009=\u2009.06). Generalized additive model analyses demonstrated significant MELD\u2009\u00d7\u2009ADI interactions for referral (\n P<\/jats:italic>\n \u2009for interaction\u2009=\u2009.01), wait-listing (\n P<\/jats:italic>\n for interaction\u2009=\u2009.004), and mortality (\n P<\/jats:italic>\n for interaction\u2009=\u2009.01). At a MELD score 20 to 30, referral probability was 40% to 60% among patients with an ADI less than 30 vs 20% among those with an ADI 30 or more. Among patients with a MELD score 20 to 30, mortality exceeded 20% in those with an ADI 60 or more compared with 10% to 20% in those with an ADI less than 20.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this multicenter cohort study of severe alcohol-associated hepatitis, neighborhood disadvantage was associated with referral at intermediate MELD scores. These findings suggest that referral is a critical leverage point for interventions and that outreach and navigation strategies informed by social context may improve access to LT.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.2567","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:30:44Z","timestamp":1773934244000},"page":"e262567","source":"Crossref","is-referenced-by-count":5,"title":["Neighborhood Disadvantage and Access to Liver Transplant Referral for Severe Alcohol-Associated Hepatitis"],"prefix":"10.1001","volume":"9","author":[{"given":"Lauren D.","family":"Nephew","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Cotter","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of 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