Cystic fibrosis patients of low SES are less likely to be accepted for lung transplant

Adult cystic fibrosis (CF) patients of low socioeconomic status (SES) have a greater chance of not being accepted for lung transplant after undergoing initial evaluation, according to a new study.

"While earlier studies have indicated that SES does not affect access to care for , ours is the first study to examine the relationship between SES and access to 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 findings were published online ahead of print publication in the 's American Journal of Respiratory and .

The study included 2,167 adult from the CF Foundation Patient registry, all of whom underwent their first lung transplant evaluation as an adult between January 1, 2001, and December 31, 2009. Receipt of Medicaid insurance was used as the primary indicator of SES status. The outcome of interest was acceptance onto the waiting list for lung transplant after initial evaluation. Patients who were either declined or deferred were classified as not accepted, and 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.

Of the 2,167 patients included in the study, 1009 (47%) received Medicaid. Compared to non-, the odds of not being accepted for lung transplant was 1.56 fold higher among Medicaid 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 study had a few limitations, including the use of Medicaid and other indicators as proxies for SES status. Furthermore, inadequate social support and poor adherence are key determinants of transplant eligibility. Although the authors attempted to account for these factors in their analysis, incomplete adjustment for these variables may at least partially explain why low SES was associated with not being accepted for lung transplant.

"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 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."

add to favorites email to friend print save as pdf

Related Stories

Racial disparities exist in access to kidney transplantation

Feb 09, 2012

A new study published in the American Journal of Transplantation reveals that racial disparities exist in both the early and late steps in access to kidney transplantation. This study is part of the February special themed ...

Recommended for you

Travel restrictions could worsen Ebola crisis: experts

2 hours ago

Travel restrictions could worsen West Africa's Ebola epidemic, limiting medical and food supplies and keeping out much-needed doctors, virologists said Tuesday as the disease continued its deadly spread.

World 'losing battle' to contain Ebola: MSF (Update)

2 hours ago

International medical agency Medecins sans Frontieres said Tuesday the world was "losing the battle" to contain Ebola as the United Nations warned of severe food shortages in the hardest-hit countries.

Mutating Ebola viruses not as scary as evolving ones

3 hours ago

My social media accounts today are cluttered with stories about "mutating" Ebola viruses. The usually excellent ScienceAlert, for example, rather breathlessly informs us "The Ebola virus is mutating faster in humans than in animal hosts ...

War between bacteria and phages benefits humans

4 hours ago

In the battle between our immune systems and cholera bacteria, humans may have an unknown ally in bacteria-killing viruses known as phages. In a new study, researchers from Tufts University, Massachusetts ...

Ebola kills 31 people in DR Congo: WHO

6 hours ago

An outbreak of the Ebola virus in the Democratic Republic of Congo has killed 31 people and the epidemic remains contained in a remote northwestern region, UN the World Health Organization (WHO) said Tuesday.

User comments