A Comparative Study of Liver Disease Care in the USA and Urban and Rural China

Dig Dis Sci. 2016 Oct;61(10):2847-2856. doi: 10.1007/s10620-016-4206-2. Epub 2016 Jun 2.


Background: Chronic liver disease is a major cause of morbidity and mortality in the USA and China, but the etiology of liver disease, medical practice, and patient expectations in these two countries are different.

Aims: To compare patient knowledge about their liver disease, patient satisfaction with liver disease care, and patient medical decision-making preference in the USA and China.

Methods: Three cohorts of established adult patients with liver disease seen in liver clinics in Ann Arbor, USA, and Beijing (urban) and Hebei (rural), China, completed a survey between May and September 2014.

Results: A total of 990 patients (395 USA, 398 Beijing, and 197 Hebei) were analyzed. Mean liver disease knowledge score (maximum 5) in the USA, Beijing, and Hebei patients was 4.1, 3.6, and 3.0, respectively (p < 0.001). US patients had a greater preference for collaborative decision-making: 71.8 % preferred to make treatment decisions together with the doctor, while most Chinese patients (74.6 % Beijing and 84.8 % Hebei) preferred passive decision-making. Mean satisfaction score (maximum 85) in the USA was higher than in Beijing, which in turn was higher than in Hebei (78.2 vs. 66.5 vs. 60.3, p < 0.001). There was a positive correlation between liver disease knowledge score and satisfaction score (r = 0.27, p < 0.001) and with collaborative medical decision-making (r = 0.22, p < 0.001) when responses from all sites were combined.

Conclusions: Liver disease knowledge and patient satisfaction were greatest in the USA, followed by Beijing and then Hebei patients. Understanding these differences and associated factors may help to improve patient outcomes.

Keywords: Cultural differences; Healthcare delivery; Hepatitis; Knowledge gaps; Medical decision-making.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • China
  • Chronic Disease
  • Decision Making
  • Female
  • Health Knowledge, Attitudes, Practice / ethnology*
  • Hepatitis B, Chronic / therapy
  • Hepatitis C, Chronic / therapy
  • Hepatitis, Autoimmune / therapy
  • Humans
  • Liver Cirrhosis, Alcoholic / therapy
  • Liver Diseases / therapy*
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / therapy
  • Patient Participation*
  • Patient Preference / ethnology*
  • Patient Satisfaction / ethnology*
  • Rural Population*
  • Surveys and Questionnaires
  • United States
  • Urban Population*