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Social determinants in liver transplantation

An accumulating body of evidence points toward the powerful role of social and environmental factors, referred to as the social determinants of health, in shaping disease patterns and outcomes. The World Health Organization has defined the social determinants of health (Table 1) as ‘‘the conditions in which people are born, grow, live, work, and age.’’ In both the developing and the developed world, social determinants likely have a greater influence on health and disease than medical care alone. Because the social determinants of health are fundamental components in the causal pathways of disease, we suggest that focusing on them in the context of liver disease will offer insights into strategies for improving health outcomes for patients with end-stage liver disease (ESLD) in the United States. In this review, we focus on access to and outcomes after liver transplantation among patients with ESLD.