Temporal trends in primary payers in pediatric heart transplant and association with long-term survival.
Temporal trends in primary payers in pediatric heart transplant and association with long-term survival.
复制标题
儿科心脏移植主要支付者的时间趋势及其与长期生存的关系。
DOI：
10.1111/petr.14484
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发表时间：
2023
影响因子：
1.3
通讯作者：
O'Connor,MatthewJ
中科院分区：
文献类型：
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作者：
Restaino,Kathryn;Zhang,Xuemei;Faerber,JenniferA;Rossano,JosephW;Burstein,Danielle;Wittlieb-Weber,CarolA;Lin,KimberlyYee;Edelson,JonathanB;Edwards,JonathanJ;O'Connor,MatthewJ
背景小儿心脏移植（HT）是资源密集型的。在成年人中，由公共保险资助的HT比例有所增加，HT后的结果不如私人来源资助的结果。儿童HT的资金和儿童结局的趋势尚未被描述。MethodsWe查询了器官共享联合网络（UNOS）数据库中列出的儿童（<18岁）和2004年至2021年之间进行HT。我们在上市、HT、1年和HT后1-5年确定了主要付款人。使用广义logit模型分析趋势。多变量扩展的考克斯回归模型被用来测试之间的关系，在移植和时间到死亡或retransplant.ResultsThere的保险类型6382儿科患者接受移植，无论是公共或私人保险在移植时。随着时间的推移，HT时有公共保险的患者比例增加。HT时的公共保险与HT后2个月后死亡或再移植的风险增加相关（6个月时的校正HR = 1.43，95% CI：1.13- 1.81，p = 0.003; 9个月时的校正HR = 1.67，95% CI：1.17- 2.37，p = 0.004）.结论对于等待HT、HT时和HT后的儿童，公共保险的增加具有统计学显著性趋势。黑人患者和那些在HT有公共保险的患者的长期结果更差。这项研究强调了儿科HT的持续差异，以及集中精力实现公平结果的必要性。
BackgroundPediatric heart transplantation (HT) is resource intensive. In adults, there has been an increase in the proportion of HTs funded by public insurance, with post‐HT outcomes inferior to those funded by private sources. Trends in the funding of pediatric HT and outcomes in children have not been described.MethodsWe queried the United Network for Organ Sharing (UNOS) database for children (<18 years) listed for and undergoing HT between 2004 and 2021. We identified the primary payer at listing, HT, 1 year, and 1–5 years following HT. Trends were analyzed using generalized logit models. Multivariable‐extended Cox regression models were used to test the relationship between insurance type at the time of transplant and time to death or re‐transplant.ResultsThere were 6382 pediatric patients who underwent transplants and had either public or private insurance at the time of transplant. The percentage of patients with public insurance at the time of HT increased over time. Public insurance at the time of HT was associated with an increased risk of death or re‐transplant beyond 2 months after HT (adjusted HR at 6 months = 1.43, 95% CI: 1.13–1.81,p= .003; adjusted HR at 9 months = 1.67, 95% CI: 1.17–2.37,p= .004).ConclusionThere has been a statistically significant trend toward increasing public insurance for children awaiting, at the time of, and after HT. Black patients and those with public insurance at HT have worse long‐term outcomes. This study highlights ongoing disparities in pediatric HT and the need to focus efforts on achieving equitable outcomes.