Sociodemographic Determinants of Waitlist and Posttransplant Survival Among End‐Stage Liver Disease Patients

While regional organ availability dominates discussions of distribution policy, community‐level disparities remain poorly understood. We studied micro‐geographic determinants of survival risk and their distribution across Donor Service Areas (DSAs). Scientific Registry of Transplant Recipients recor...

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Veröffentlicht in:American journal of transplantation 2017-11, Vol.17 (11), p.2879-2889
Hauptverfasser: Ross, K., Patzer, R. E., Goldberg, D. S., Lynch, R. J.
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container_end_page 2889
container_issue 11
container_start_page 2879
container_title American journal of transplantation
container_volume 17
creator Ross, K.
Patzer, R. E.
Goldberg, D. S.
Lynch, R. J.
description While regional organ availability dominates discussions of distribution policy, community‐level disparities remain poorly understood. We studied micro‐geographic determinants of survival risk and their distribution across Donor Service Areas (DSAs). Scientific Registry of Transplant Recipients records for all adults waitlisted for liver transplantation 2002–2014 were reviewed. The primary exposure variables were county‐level sociodemographic risk, as measured by the Community Health Score (CHS), a previously‐validated composite index local health conditions, and distance to listing transplant center. Among 114 347 patients, the median CHS was 19.4 (range: 0–40). Compared the lowest risk counties (CHS 1–10), highest‐risk counties (CHS 31–40) had more black (14.6% vs. 5.4%), publicly insured (44.9% vs. 33.0), and remote candidates (34.0% vs. 15.1% living >100 miles away). Higher‐CHS candidates had greater waitlist mortality in Cox multivariable (HR 1.16 for CHS 31–40, 95% CI 1.11–1.21) and competing risks analysis (sHR 1.07, 95% CI 0.99–1.14). Post‐transplant survival was similar across CHS quartiles. Living >25 miles from the transplant center conferred excess mortality risk (sHR 1.08, 95% CI 1.03–1.12). Proposed distribution changes would disproportionately impact DSAs with more high‐CHS or distant candidates. Low‐income, rural and minority patients experience excess mortality while awaiting transplant, and risk disproportionately worse outcomes with reduced organ availability under current proposals. The authors examine the mortality risk associated with a sociodemographically disadvantaged place of residence for liver transplant candidates, as well as implications of liver redistribution on transplant access for these patients. See the editorial from Axelrod and Yeh on page 2759 .
doi_str_mv 10.1111/ajt.14421
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Compared the lowest risk counties (CHS 1–10), highest‐risk counties (CHS 31–40) had more black (14.6% vs. 5.4%), publicly insured (44.9% vs. 33.0), and remote candidates (34.0% vs. 15.1% living &gt;100 miles away). Higher‐CHS candidates had greater waitlist mortality in Cox multivariable (HR 1.16 for CHS 31–40, 95% CI 1.11–1.21) and competing risks analysis (sHR 1.07, 95% CI 0.99–1.14). Post‐transplant survival was similar across CHS quartiles. Living &gt;25 miles from the transplant center conferred excess mortality risk (sHR 1.08, 95% CI 1.03–1.12). Proposed distribution changes would disproportionately impact DSAs with more high‐CHS or distant candidates. Low‐income, rural and minority patients experience excess mortality while awaiting transplant, and risk disproportionately worse outcomes with reduced organ availability under current proposals. 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E.</creatorcontrib><creatorcontrib>Goldberg, D. S.</creatorcontrib><creatorcontrib>Lynch, R. J.</creatorcontrib><title>Sociodemographic Determinants of Waitlist and Posttransplant Survival Among End‐Stage Liver Disease Patients</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>While regional organ availability dominates discussions of distribution policy, community‐level disparities remain poorly understood. We studied micro‐geographic determinants of survival risk and their distribution across Donor Service Areas (DSAs). Scientific Registry of Transplant Recipients records for all adults waitlisted for liver transplantation 2002–2014 were reviewed. The primary exposure variables were county‐level sociodemographic risk, as measured by the Community Health Score (CHS), a previously‐validated composite index local health conditions, and distance to listing transplant center. 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The authors examine the mortality risk associated with a sociodemographically disadvantaged place of residence for liver transplant candidates, as well as implications of liver redistribution on transplant access for these patients. 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Low‐income, rural and minority patients experience excess mortality while awaiting transplant, and risk disproportionately worse outcomes with reduced organ availability under current proposals. The authors examine the mortality risk associated with a sociodemographically disadvantaged place of residence for liver transplant candidates, as well as implications of liver redistribution on transplant access for these patients. See the editorial from Axelrod and Yeh on page 2759 .</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>28695615</pmid><doi>10.1111/ajt.14421</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record>
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subjects End Stage Liver Disease - mortality
End Stage Liver Disease - surgery
Female
Follow-Up Studies
Health Services Accessibility
health services and outcomes research
Humans
liver disease
Liver diseases
Liver transplantation
Liver Transplantation - mortality
liver transplantation/hepatology
Male
Middle Aged
Mortality
organ allocation
organ procurement and allocation
Prognosis
Registries
Retrospective Studies
Risk Factors
Sociodemographics
Socioeconomic Factors
Survival
Survival Rate
Tissue and Organ Procurement
Tissue Donors - supply & distribution
Transplant Recipients
Transplantation
Transplants & implants
Waiting Lists
waitlist management
title Sociodemographic Determinants of Waitlist and Posttransplant Survival Among End‐Stage Liver Disease Patients
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