This article was originally published here
J Am Coll Surg. 2021 Jan 11:S1072-7515(21)00001-6. doi: 10.1016/j.jamcollsurg.2020.12.021. Online ahead of print.
ABSTRACT
BACKGROUND: Previous studies have demonstrated disparities in transplantation for women, non-Caucasians, the uninsured or publicly insured, and rural populations. We sought to correlate transplant center characteristics with patient access to the waiting list and liver transplantation.
HYPOTHESIS: Liver transplant centers vary greatly in providing equitable access to the waiting list and liver transplantation.
STUDY DESIGN: Center-specific adult deceased donor liver transplant and waitlist data for the years 2013 to 2018 were obtained from the Scientific Registry of Transplant Recipients. Waitlist race/ethnicity distributions from liver transplant centers performing ≥250 transplants over this period (n=109) were compared with those of their Donor Service Area, as calculated from 5-year US Census Bureau estimates of 2017. Center-specific characteristics correlated with disparities were analyzed using a linear regression model with a log transformed outcome.
RESULTS: Non-Hispanic Blacks (NHBs) are underrepresented in liver transplant listing compared to center Donation Service Area (88/109, 81%), whereas non-Hispanic Whites are overrepresented (65/109, 58%) (p<0.0001). Hispanics were also underrepresented on the waitlist at the majority of transplant centers (68/109, 62%) (p=0.02). While the racial/ethnic distribution of transplantation is more reflective of the waitlist, there is a higher than expected rate of transplantation for NHBs compared to the waitlist. Predictors of disparity in listing include percentage of transplant recipients at the center who had private insurance, racial composition of the Donation Service Area, and the distance recipients had to travel for transplant.
CONCLUSIONS: Non-Hispanic Blacks are listed for liver transplantation less than would be expected. Once listed, however, racial disparities in transplantation are greatly diminished. Improvements in access to adequate health insurance appears to be essential to diminishing disparities in access to this life-saving care.
PMID:33444709 | DOI:10.1016/j.jamcollsurg.2020.12.021
