Insurance status is an independent predictor of long-term survival after lung transplantation in the United States
Insurance status is an independent predictor of long-term survival after lung transplantation in the United States
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DOI：
10.1016/j.healun.2010.07.003
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发表时间：
2011-01-01
影响因子：
8.9
通讯作者：
Merlo, Christian A.
中科院分区：
文献类型：
--
作者：
Allen, Jeremiah G.;Arnaoutakis, George J.;Merlo, Christian A.
背景：众所周知，社会经济因素如教育、健康保险和种族会影响健康结果。器官共享的联合网络（UNOS）数据库提供了一个大型队列的肺移植（LTx）收件人，以评估保险对survival.METHODS的影响：我们回顾性分析了11,385成人原发性LTx患者（1998 - 2008）的UNOS数据。按保险（私人/自费、医疗保险、医疗补助和其他类型）对患者进行分层。采用包含14个变量的考克斯比例风险回归分析全因死亡率。Kaplan-Meier方法用于模拟LTx后的生存率。结果：在11，385名接受者中，7，100人（62.4%）有私人保险/自费; 2，966人（26.1%）有医疗保险; 815人（7.2%）有医疗补助; 504人（4.4%）有其他类型的保险。在研究期间，4，943名患者（43.4%）死亡。医疗保险和医疗补助患者的10年生存率分别比私人保险/自费患者低7.0%和8.1%。保险不影响30天、90天或1年生存率。医疗保险和医疗补助患者在3年及更长时间内的生存率下降。在多变量分析中，医疗保险（风险比，1.10; 95%置信区间，1.03-1.19）和医疗补助（风险比，1.29; 95%置信区间，1.15-1.45）显著增加死亡风险。当第一年的死亡被排除在外，生存差异stressed.CONCLUSIONS：这项研究是最大的队列评估后LTx生存保险的影响。与私人保险/自费患者相比，医疗保险和医疗补助患者在LTx后的生存率更低。J Heart Lung Transplant 2011;30：45-53（C）2011年国际心肺移植学会。All rights reserved.
BACKGROUND: Socioeconomic factors such as education, health insurance, and race are known to affect health outcomes. The United Network for Organ Sharing (UNOS) database provides a large cohort of lung transplant (LTx) recipients in which to evaluate the effect of insurance on survival.METHODS: We retrospectively reviewed UNOS data for 11,385 adult primary LTx patients (1998 2008). Patients were stratified by insurance (private/self-pay, Medicare, Medicaid, and other type). All-cause mortality was examined with Cox proportional hazard regression incorporating 14 variables. The Kaplan-Meier method was used to model survival after LTx.RESULTS: Of 11,385 recipients, 7,100 (62.4%) had private insurance/self-pay; 2,966 (26.1%) had Medicare; 815 (7.2%) had Medicaid; and 504 (4.4%) had other type insurance. During the study, 4,943 patients (43.4%) died.. Medicare and Medicaid patients had 7.0% and 8.1% lower 10-year survival than did private insurance/self-pay patients, respectively. Insurance did not affect 30-day, 90-day, or 1-year survival. Medicare and Medicaid patients had decreased survival at 3 years and longer. In multivariable analyses, Medicare (hazard ratio, 1.10; 95% confidence interval, 1.03-1.19) and Medicaid (hazard ratio, 1.29; 95% confidence interval, 1.15-1.45) significantly increased risk of death. When deaths in the first year were excluded, survival differences persisted.CONCLUSIONS: This study represents the largest cohort evaluating the effect of insurance on post-LTx survival. Medicare and Medicaid patients have worse survival after LTx compared with private insurance/self-paying patients. J Heart Lung Transplant 2011;30:45-53 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.