Racial differences in access to lung transplantation in the United States across geographic region Pubblico

Abstract

Objective: Prior to the introduction of a major change in the national allocation system for lung transplantation in 2005, African-Americans were less likely to receive lung transplants than Caucasians. While prior studies have shown that racial disparities have decreased in the post-policy era, no studies have re-examined racial disparities after accounting for differences in socioeconomic status, insurance status, and distance to transplant center. Additionally, no studies have identified whether or not there are regional variations in racial differences in transplant access.

Methods: We performed a retrospective cohort study on all candidates for lung transplantation waitlisted between May 4, 2005 and September 30, 2014. After performing all exclusions, our cohort included 19,162 subjects, whom we stratified by race and OPTN region. Multivariate regression was performed in order to determine the role of race in likelihood of transplantation within three years.

Results: There were no significant differences between mean times to transplantation or likelihood of transplantation within three years when comparing African-Americans and Caucasians on both a national and regional level.

Conclusions: No racial differences in likelihood of lung transplantation exist in any of the 11 OPTN regions. The current method of lung allocation provides an effective and objective way to allocate lungs in a way that limits racial disparities, even when adjusting for demographic factors, insurance status, and distance to transplant center.

Table of Contents

Chapter I: Background ………………………………………………,…………….....1

Epidemiology of Lung Disease ……………………………………….……………...1

Lung Allocation and the Introduction of the LAS…………………….………….2

End-Stage Lung Disease Risk Factors and the Role of Race, Socioeconomic Status (SES), and Geography……………………………..4

Racial Disparities in Lung Transplantation…………………………………………6

Geographic Disparities in Lung Transplantation………………………………….7

Chapter II: Manuscript…………………………………………………………………..8

Introduction…………………………………………………………………………….....8

Methods……………………………………………………………………………….......11

Study Population……………………………………………………………...............11

Data Cleaning…………………………………………………………………..............11

Data Collection………………………………………………………………...............12

Analysis………………………………………………………………................………13

Results………………………………………………………………………….......……..14

Discussion………………………………………….……………………………......…...16

Study Limitations…………………………………………………………..............….18

Conclusions………………………………………………………………....................19

References………………………………………………………………………….......…20

Tables and Figures…………………………………………………………………....….23

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Parola chiave	Transplant
Committee Chair / Thesis Advisor	Patzer, Rachel Elizabeth, Emory University

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