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

September 14, 2012

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."

Explore further: Vitamin D deficiency shown to increase rejection rates in lung transplant patients

Related Stories

Vitamin D deficiency shown to increase rejection rates in lung transplant patients

April 25, 2012
(Medical Xpress) -- Vitamin D deficiency is associated with an increase in lung transplant rejection and infections, according to research conducted at Loyola University Health System (LUHS). Researchers also found that recipients ...

Racial disparities exist in access to kidney transplantation

February 9, 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 ...

Policy of including smokers in donor pool improves survival rates for patients on lung transplant waiting lists

May 28, 2012
New research shows that lung transplant patients who receive the lungs of smokers have a better overall chance of survival than those who remain on waiting lists, despite the fact that they tend to survive for a shorter period ...

Delayed access to tertiary care associated with higher death rate from type of pulmonary fibrosis

July 1, 2011
Idiopathic pulmonary fibrosis (IPF)―scarring and thickening of the lungs from unknown causes―is the predominant condition leading to lung transplantation nationwide. Columbia University Medical Center researchers ...

Recommended for you

Two Group A Streptococcus genes linked to 'flesh-eating' bacterial infections

September 22, 2017
Group A Streptococcus bacteria cause a variety of illnesses that range from mild nuisances like strep throat to life-threatening conditions including pneumonia, toxic shock syndrome and the flesh-eating disease formally known ...

Ecosystem approach makes urinary tract infection more treatable

September 22, 2017
The biological term 'ecosystem' is not usually associated with urinary tract infections, but this should change according to Wageningen scientists.

Residents: Frontline defenders against antibiotic resistance?

September 22, 2017
Antibiotic resistance continues to grow around the world, with sometimes disastrous results. Some strains of bacteria no longer respond to any currently available antibiotic, making death by infections that were once easily ...

Superbug's spread to Vietnam threatens malaria control

September 21, 2017
A highly drug resistant malaria 'superbug' from western Cambodia is now present in southern Vietnam, leading to alarming failure rates for dihydroartemisinin (DHA)-piperaquine—Vietnam's national first-line malaria treatment, ...

Investigators may unlock mystery of how staph cells dodge the body's immune system

September 21, 2017
For years, medical investigators have tried and failed to develop vaccines for a type of staph bacteria associated with the deadly superbug MRSA. But a new study by Cedars-Sinai investigators shows how staph cells evade the ...

A dose of 'wait-and-see' reduces unnecessary antibiotic use

September 21, 2017
Asking patients to take a 'wait-and-see' approach before having their antibiotic prescriptions filled significantly reduces unnecessary use, a University of Queensland study has shown.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.