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Geographic disparity: the dilemma of lower socioeconomic status, multiple listing, and death on the liver transplant waiting list
Author(s) -
Schwartz Adam,
Schiano Thomas,
KimSchluger Leona,
Florman Sander
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12429
Subject(s) - medicine , united network for organ sharing , medicaid , socioeconomic status , demography , waiting list , liver transplantation , incentive , transplantation , gerontology , emergency medicine , environmental health , health care , population , sociology , economics , microeconomics , economic growth
Due to the current regionally based allocation system, some patients list for and are transplanted away from home in regions with shorter waits and higher transplant rates. Of 147 included patients, 120 died waiting and 27 received transplants at outside centers during the study (32.5 months). Those transplanted elsewhere had higher median incomes than patients dying on the waitlist ($84 946 vs. $55 250, p = 0.0001). Those with median incomes <$60 244 were more likely to die than those with incomes >$60 244 (94% vs. 70%, RR : 1.35, 95% CI : 1.14–1.59). Patients with Medicaid were more likely to die waiting than those with other insurance (100% vs. 77%, RR : 1.30, 95% CI : 1.18–1.44). Our analysis demonstrates that those who died waiting were more likely to have lower incomes and Medicaid compared with those transplanted elsewhere. Even when we controlled for Medicaid status, patients who died waiting had lower incomes compared with those transplanted elsewhere. Increased organ sharing over geographically broader regions, as recommended by the I nstitute of M edicine in 1999, may reduce incentives for patients to travel to receive a liver and reduce inequities. Current efforts to address this disparity continue to fall short of the I nstitute of M edicine recommendations, U nited S tates D epartment of H ealth and H uman S ervices regulations and the Final Rule.