Following the Organ Supply
| Autor: | Sommer E. Gentry, Nino Dzebisashvili, Krista L. Lentine, Janet E. Tuttle-Newhall, Richard B. Freeman, Allan B. Massie, Mark A. Schnitzler, David A. Axelrod, Dorry L. Segev |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Waiting Lists Matched-Pair Analysis medicine.medical_treatment Kaplan-Meier Estimate Liver transplantation Risk Assessment Health Services Accessibility White People ABO Blood-Group System Young Adult Residence Characteristics Risk Factors medicine Humans Registries Healthcare Disparities Intensive care medicine Prospective cohort study Socioeconomic status Proportional Hazards Models Retrospective Studies Travel Transplantation Insurance Health Proportional hazards model business.industry Hazard ratio Hispanic or Latino Middle Aged Tissue Donors United States Confidence interval Liver Transplantation Black or African American Treatment Outcome Socioeconomic Factors Quartile Multivariate Analysis Linear Models Tissue and Organ Harvesting Female business Demography |
| Zdroj: | Transplantation Journal. 95:361-371 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0b013e3182737cfb |
| Popis: | BACKGROUND Disparity in access to liver transplantation (LT) in the United States persists despite directives from the federal government to reduce geographic variation. We assessed the impact of socioeconomic status (SES) and traveling to alternative donation service areas (DSAs) on patient survival. METHODS A prospective cohort study integrating transplant registry and U.S. Census data was analyzed using multivariate linear Cox proportional hazards models. A separate matched-pairs analysis was used to assess the benefit of traveling on patient survival and transplantation rate. RESULTS High SES is associated with increased access to LT (adjusted hazard ratio [aHR], 1.05; 95% confidence interval [95% CI], 1.01-1.08) and reduced mortality after waitlisting (aHR [95% CI], 0.88 [0.85-0.93]). Increased access is mediated, in part, through inter-DSA travel. Travel was associated with high SES, white race, blood group O, private insurance, and residence in regions 1, 5, and 11. Transplant candidates in the highest SES quartile were approximately 70% more likely to travel (aHR [95% CI], 1.67 [1.43-1.97]) than those in the lowest SES quartile. Compared with matched control patients, travelers were 74% more likely to be transplanted (aHR [95% CI], 1.74 [1.56-1.94]) and 20% less likely to die after listing (aHR [95% CI], 0.79 [0.69-0.92]). CONCLUSION High SES and inter-DSA travel are strongly associated with increased LT access and reduced mortality. Travelers are more likely to be sociodemographically advantaged and privately insured and to live in regions with reduced access to deceased-donor organs. |
| Databáze: | OpenAIRE |
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