Racial and ethnic disparities in lung transplant listing and waitlist outcomes

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:37

Article

Mooney, Joshua J.¹  Hedlin, Haley²  Mohabir, Paul¹  Bhattacharya, Jay³  Dhillon, Gundeep S.¹ 

[1] Stanford Univ, Dept Med, Div Pulm & Crit Care, Stanford, CA 94305 USA

[2] Stanford Univ, Dept Med, Quantitat Sci Unit, Stanford, CA 94305 USA

[3] Stanford Univ, Dept Med, Ctr Primary Care & Outcomes Res, Stanford, CA 94305 USA

关键词: lung transplant;    disparities;    race/ethnicity;    waitlist;    organ allocation;   

DOI  :  10.1016/j.healun.2017.09.017

来源: Elsevier

【 摘 要 】

BACKGROUND: The United States lung transplant registry data demonstrate differences in adult waitlist mortality by race/ethnicity. It is unknown whether these differences persist after risk adjustment or occur secondary to disparities in disease severity at the time of listing. METHODS: Adult lung transplant waitlist candidates between May 4, 2005 and March 5, 2015 were identified and compared by non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic and Asian race/ethnicity. A competing risk proportional hazards model was used to assess the association of race/ethnicity with the unadjusted and adjusted risk of waitlist death or removal for too sick, transplant, or removal for other reason. Disease illness severity at transplant listing was compared by race/ethnicity. RESULTS: There were 20,684 lung transplant candidates identified (82% NHW, 9% NHB, 6% Hispanic, 2% Asian and 1% other). Non-white candidates had higher unadjusted waitlist mortality, which was fully mitigated by adjusting for other risk factors (NHB: hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.93 to 1.18; Hispanic: HR 1.02, 95% CI 0.99 to 1.18; Asian: HR 0.90, 95% CI 0.70 to 1.16). Adjusted waitlist access to transplant was lower in non-white candidates (NHB: HR 0.88, 95% CI 0.83 to 0.94; Hispanic: HR 0.87, 95% CI 0.81 to 0.94; Asian: HR 0.83, 95% CI 0.73 to 0.96). NHW candidates with obstructive lung disease and pulmonary fibrosis were older with less illness severity at listing than non-white candidates. CONCLUSIONS: Within the current lung allocation system, there is no difference in risk-adjusted waitlist mortality by race/ethnicity, but non-white waitlist candidates have lower risk-adjusted access to lung transplant. Non-white candidates are generally younger with greater disease-specific illness severity at the time of lung transplant listing. (C) 2018 Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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