Sociodemographic Differences in Early Access to Liver Transplantation Services
Sociodemographic Differences in Early Access to Liver Transplantation Services
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DOI：
10.1111/j.1600-6143.2009.02737.x
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发表时间：
2009-09-01
影响因子：
8.8
通讯作者：
Roberts, M. S.
中科院分区：
文献类型：
--
作者：
Bryce, C. L.;Angus, D. C.;Roberts, M. S.
在终末期肝病（ESLD）患者被列入移植候补名单之前是否会出现医疗保健不平等的问题此前尚未得到评估。为了确定性别、种族和保险对移植机会的影响，我们将宾夕法尼亚州 1994 年至 2001 年间从非政府医院出院的成年患者的数据来源联系起来。我们对患者进行了 2003 年的跟踪调查，并将信息与负责这一时期宾夕法尼亚州 95% 肝移植的五个中心的记录联系起来。使用多项逻辑回归，我们估计了患者接受移植评估、移植等待和移植本身的概率。在该研究的 144507 名患者中，4361 名 (3.0%) 接受了移植评估。在接受评估的人中，有 3071 人（70.4%）被列入候补名单。在候补名单中，1537 人（50.0%）接受了移植手术。总体而言，研究期间有 57 020 人（39.5%）死亡。如果患者是女性、黑人且缺乏商业保险，则接受评估、候补和移植的可能性较小（均 < 0.001）。早期阶段（评估和列入）的差异比移植阶段（进行国家监督和审查）更为明显。为了更好地理解 ESLD 患者的早期管理和治疗决策，需要有关转诊和列出实践的更全面的数据。
The question of whether health care inequities occur before patients with end-stage liver disease (ESLD) are waitlisted for transplantation has not previously been assessed. To determine the impact of gender, race and insurance on access to transplantation, we linked Pennsylvania sources of data regarding adult patients discharged from nongovernmental hospitals from 1994 to 2001. We followed the patients through 2003 and linked information to records from five centers responsible for 95% of liver transplants in Pennsylvania during this period. Using multinomial logistic regressions, we estimated probabilities that patients would undergo transplant evaluation, transplant waitlisting and transplantation itself. Of the 144 507 patients in the study, 4361 (3.0%) underwent transplant evaluation. Of those evaluated, 3071 (70.4%) were waitlisted. Of those waitlisted, 1537 (50.0%) received a transplant. Overall, 57 020 (39.5%) died during the study period. Patients were less likely to undergo evaluation, waitlisting and transplantation if they were women, black and lacked commercial insurance (p < 0.001 each). Differences were more pronounced for early stages (evaluation and listing) than for the transplantation stage (in which national oversight and review occur). For early management and treatment decisions of patients with ESLD to be better understood, more comprehensive data concerning referral and listing practices are needed.