Poor CF patients less likely to receive lung transplants

Source：University of Washington Medical Release Date：2012-09-19 211

Medical Equipment

Adult cystic fibrosis (CF) patients of low socio-economic status in the U.S. associated with greater odds of not being accepted for transplant

A U.S.-based study has found that adult cystic fibrosis (CF) patients of low socio-economic status (SES) are less likely to be being accepted for lung transplant after undergoing initial evaluation.

“While earlier studies have indicated that SES does not affect access to care for cystic fibrosis, ours is the first study to examine the relationship between SES and access to lung transplantation in these patients,” said lead author Bradley S. Quon, MD, MSc, MBA, of the University of Washington Medical Center in Seattle. “In our nationally representative sample of adult patients with CF, we found that multiple indicators of SES were associated with greater odds of not being accepted for transplant.”

The study was published online in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine. It included 2,167 adult CF patients from the CF Foundation Patient registry who underwent their first lung transplant evaluation as an adult between January 1, 2001, and December 31, 2009. Medicaid insurance receipts were used as the primary indicator of SES. The outcome of interest was acceptance onto the waiting list for lung transplant after initial evaluation, and patients who were declined or deferred were classified as not accepted. An additional sensitivity analysis was performed based on the final decision of whether a patient was accepted or declined at the end of the study period.

The findings showed 1009 (47%) patients received Medicaid, with the odds of not being accepted for lung transplant being1.56 fold higher among Medicaid recipients compared to non-recipients. This relationship was independent of differences in disease severity, demographic factors, contraindications to lung transplant, and use of the lung allocation score.

Other indicators of low SES, including residing in lower income zip codes and not graduating from high school, were also independently associated with not being accepted for lung transplant after undergoing initial evaluation.

“The results of our study are concerning, as the effects of SES status on access to lung transplant appear to be unrelated to differences in disease severity or potential contraindications,” said Dr. Quon. “More research is needed to explore the factors associated with Medicaid status that negatively impact lung transplant access and to assess whether these disparities are seen in other pre-lung transplant patient populations.”Lebron Soldiers X 10