Outcomes of liver transplantation by insurance types in the United States
| Autor: | Chapy Venkatesan, Zobair M. Younossi, Saleh Al Qahtani, Maria Stepanova, Alita Mishra, Issah Younossi |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Alcoholic liver disease Multivariate analysis Waiting Lists medicine.medical_treatment 030230 surgery Liver transplantation Medicare Health Services Accessibility Insurance Coverage 03 medical and health sciences 0302 clinical medicine Internal medicine Outcome Assessment Health Care medicine Humans Retrospective Studies Insurance Health Medicaid business.industry Health Policy Hazard ratio Retrospective cohort study Odds ratio Middle Aged medicine.disease United States Liver Transplantation Hepatocellular carcinoma Female 030211 gastroenterology & hepatology business |
| Zdroj: | The American Journal of Managed Care. 26:e121-e126 |
| ISSN: | 1936-2692 1088-0224 |
| Popis: | Objectives The outcomes of liver transplantation may vary according to socioeconomic factors such as insurance coverage. The aim of this study was to assess the association between the type of insurance payer and outcomes of liver transplant candidates and recipients in the United States. Study design This was a retrospective cohort study of a national database. Methods The US Scientific Registry of Transplant Recipients was used to select adults (≥18 years) wait-listed for liver transplantation in the United States (2001-2017); patients were followed until March 2018. Results There were 177,862 liver transplant candidates with payer and outcomes data: The mean (SD) age was 54.1 (10.4) years, 64% were male, 39% had chronic hepatitis C with or without alcoholic liver disease (ALD), 19% had ALD alone, 17% had nonalcoholic steatohepatitis, and 16% had hepatocellular carcinoma. Fifty-nine percent were primarily covered by private insurance, 21% by Medicare, and 16% by Medicaid. After listing, 56% eventually received transplants (mean wait time of 229 days) and 22% dropped off the list. In multivariate analysis, adjusted for demographic and clinical factors, being covered by Medicare (odds ratio [OR], 0.81; 95% CI, 0.78-0.84) or Medicaid (OR, 0.76; 95% CI, 0.73-0.79) was independently associated with a lower chance of receiving a transplant (reference: private insurance). Posttransplant mortality was 11.6% at 1 year, 20.1% at 3 years, 26.8% at 5 years, and 41.6% at 10 years. Having Medicare (adjusted hazard ratio [aHR], 1.24; 95% CI, 1.17-1.31) or Medicaid (aHR, 1.14; 95% CI, 1.06-1.21) was independently associated with higher posttransplant mortality (P .05). Conclusions Liver transplant candidates covered by Medicare or Medicaid have poorer wait-list outcomes and higher posttransplant mortality. |
| Databáze: | OpenAIRE |
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