Geographic disparities in lung transplant rates
Geographic disparities in lung transplant rates
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DOI：
10.1111/ajt.15182
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发表时间：
2019-05-01
影响因子：
8.8
通讯作者：
Gentry, Sommer E.
中科院分区：
文献类型：
--
作者：
Kosztowski, Martin;Zhou, Sheng;Gentry, Sommer E.
2017年11月，为了应对纽约市一名肺移植候选人的诉讼，对肺分配政策进行了紧急修改，取消了捐赠服务区（DSA）作为分配的第一地理层。该诉讼声称，DSA边界是任意的，分配应该基于医疗优先级。我们调查了在政策改变之前，美国DSA之间的死亡供体肺移植（LT）率是否存在实质性差异。我们使用多水平泊松回归和经验贝叶斯方法估计了每活跃人年的LT率。我们发现DSA之间移植率的中位发病率比（MIRR）为2.05，这意味着候选人可以通过改变DSA使其LT率增加一倍。这可以直接与LT率增加1.54倍进行比较，我们发现与肺分配评分（LAS）类别从38-42增加到42-50相关。改变候选人的每日生活津贴对候选人的长期合同费率的影响要大于将劳工会计制度类别从38-42改为42-50。总之，我们发现，在紧急肺分配变更之前，登记DSA是全国范围内候选人LT率的主要决定因素。
In November 2017, in response to a lawsuit from a New York City lung transplant candidate, an emergency change to the lung allocation policy eliminated the donation service area (DSA) as the first geographic tier of allocation. The lawsuit claimed that DSA borders are arbitrary and that allocation should be based on medical priority. We investigated whether deceased-donor lung transplant (LT) rates differed substantially between DSAs in the United States before the policy change. We estimated LT rates per active person-year using multilevel Poisson regression and empirical Bayes methods. We found that the median incidence rate ratio (MIRR) of transplant rates between DSAs was 2.05, meaning a candidate could be expected to double their LT rate by changing their DSA. This can be compared directly to a 1.54-fold increase in LT rate that we found associated with an increase in lung allocation score (LAS) category from 38-42 to 42-50. Changing a candidate's DSA would have had a greater impact on the candidate's LT rate than changing LAS categories from 38-42 to 42-50. In summary, we found that the DSA of listing was a major determinant of LT rate for candidates across the country before the emergency lung allocation change.