Reviewer’ s report
Title: Racial Disparities of Black Americans Hospitalized for Decompensated Liver Cirrhosis
Version: 0Date: 09 Feb 2020
Reviewer: Alexandra Alexopoulou
Reviewer's report:
The article by Ted Spiewak et al is an interesting and well written, retrospective study on
differences in health care system among races in Americans hospitalized for decompensated livercirrhosis. They found differences in the kind of insurance and the amount of income betweenBlack and Whites. They also demonstrated that Black patients had the highest mean total hospitaladmissions and the highest mean number of 30-day re-admissions compared to all other racialgroups and that the race was an independent predictor of 90-day readmission.
Comments
1.Many readers may not be familiar with the different types of insurance in United States. What isthe difference between Medi-cal and Medicare insurance? In addition what is the differencebetween Medicaid and private insurance? Please explain in simple words what are the maincharacteristics of these different kind of insurances. Which is the «cheapest», feasible or accessiblein persons with low income? Which is the most accessible in order from low to high incomes?
2.How do you explain the low income in Black patients and the higher rate of insurance?3.In Table 5, it is apparent that hepatic encephalopathy and ascites are independent risk factors of
30-day hospital readmissions. Both are complications indicating the severity of cirrhosis but not
included in the MELD-Na equation. However, they are included in Child Pugh score parameters.There was no difference in MELD-Na between different races. However, it is possible that Blackpatients had a more severe liver disease that could not be evaluated by MELD-Na. The estimationof the severity of disease by Child-Pugh score could be better from this point of view and couldexplain why Black patients had the highest number of readmissions.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
YesAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
'I declare that I have no competing interestsI agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named reportincluding any attachments I upload will be posted on the website along with the authors'responses. I agree for my report to be made available under an Open Access Creative Commons
CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments
which I do not wish to be included in my named report can be included as confidential comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal
Reviewer’ s report
Title: Racial Disparities of Black Americans Hospitalized for Decompensated Liver Cirrhosis
Version: 0Date: 09 Feb 2020
Reviewer: Alexandra Alexopoulou
Reviewer's report:
The article by Ted Spiewak et al is an interesting and well written, retrospective study on
differences in health care system among races in Americans hospitalized for decompensated livercirrhosis. They found differences in the kind of insurance and the amount of income betweenBlack and Whites. They also demonstrated that Black patients had the highest mean total hospitaladmissions and the highest mean number of 30-day re-admissions compared to all other racialgroups and that the race was an independent predictor of 90-day readmission.
Comments
1.Many readers may not be familiar with the different types of insurance in United States. What isthe difference between Medi-cal and Medicare insurance? In addition what is the differencebetween Medicaid and private insurance? Please explain in simple words what are the maincharacteristics of these different kind of insurances. Which is the «cheapest», feasible or accessiblein persons with low income? Which is the most accessible in order from low to high incomes?
2.How do you explain the low income in Black patients and the higher rate of insurance?3.In Table 5, it is apparent that hepatic encephalopathy and ascites are independent risk factors of
30-day hospital readmissions. Both are complications indicating the severity of cirrhosis but not
included in the MELD-Na equation. However, they are included in Child Pugh score parameters.There was no difference in MELD-Na between different races. However, it is possible that Blackpatients had a more severe liver disease that could not be evaluated by MELD-Na. The estimationof the severity of disease by Child-Pugh score could be better from this point of view and couldexplain why Black patients had the highest number of readmissions.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
YesAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
'I declare that I have no competing interestsI agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named reportincluding any attachments I upload will be posted on the website along with the authors'responses. I agree for my report to be made available under an Open Access Creative Commons
CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments
which I do not wish to be included in my named report can be included as confidential comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal
Please review this paper.
user
Reviewer’ s report
Title: Racial Disparities of Black Americans Hospitalized for Decompensated Liver Cirrhosis
Version: 0Date: 09 Feb 2020
Reviewer: Alexandra Alexopoulou
Reviewer's report:
The article by Ted Spiewak et al is an interesting and well written, retrospective study on
differences in health care system among races in Americans hospitalized for decompensated livercirrhosis. They found differences in the kind of insurance and the amount of income betweenBlack and Whites. They also demonstrated that Black patients had the highest mean total hospitaladmissions and the highest mean number of 30-day re-admissions compared to all other racialgroups and that the race was an independent predictor of 90-day readmission.
Comments
1.Many readers may not be familiar with the different types of insurance in United States. What isthe difference between Medi-cal and Medicare insurance? In addition what is the differencebetween Medicaid and private insurance? Please explain in simple words what are the maincharacteristics of these different kind of insurances. Which is the «cheapest», feasible or accessiblein persons with low income? Which is the most accessible in order from low to high incomes?
2.How do you explain the low income in Black patients and the higher rate of insurance?3.In Table 5, it is apparent that hepatic encephalopathy and ascites are independent risk factors of
30-day hospital readmissions. Both are complications indicating the severity of cirrhosis but not
included in the MELD-Na equation. However, they are included in Child Pugh score parameters.There was no difference in MELD-Na between different races. However, it is possible that Blackpatients had a more severe liver disease that could not be evaluated by MELD-Na. The estimationof the severity of disease by Child-Pugh score could be better from this point of view and couldexplain why Black patients had the highest number of readmissions.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
YesAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
'I declare that I have no competing interestsI agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named reportincluding any attachments I upload will be posted on the website along with the authors'responses. I agree for my report to be made available under an Open Access Creative Commons
CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments
which I do not wish to be included in my named report can be included as confidential comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal
assistant