Racial Disparity in Liver Transplantation Listing.
Racial Disparity in Liver Transplantation Listing.
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DOI：
10.1016/j.jamcollsurg.2020.12.021
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发表时间：
2021-04
影响因子：
5.2
通讯作者：
Zarrinpar A
中科院分区：
文献类型：
--
作者：
Warren C;Carpenter AM;Neal D;Andreoni K;Sarosi G;Zarrinpar A
以前的研究表明，妇女、非高加索人、未参保或公共参保的人和农村人口在移植方面存在差异。我们试图将移植中心的特征与患者进入等待名单和肝移植联系起来。我们假设，肝移植中心在提供公平的等待名单和肝移植方面存在很大差异。2013年至2018年的特定中心、成人、已故捐赠者肝脏移植和等待名单的数据是从器官共享联合网络获得的。根据美国人口普查局2017年的5年估计，将这段时间内(n=109)进行≥250移植的肝脏移植中心的等待种族/民族分布与其捐赠者服务区的种族/民族分布进行了比较。使用具有对数转换结果的线性回归模型来分析与差异相关的中心特定特征。与中心捐献服务区相比，非西班牙裔黑人(NHBs)在肝脏移植名单中的比例偏低(88/109，81%)，而非西班牙裔白人比例过高(65/109，58%)(p<；0.0001)。在大多数移植中心的等待名单上，拉美裔的比例也很低(68/109，62%)(p=0.02)。尽管移植的种族/民族分布更多地反映了等待名单，但与等待名单相比，NHBs的移植比率高于预期。在名单上存在差异的预测因素包括该中心拥有私人保险的移植接受者的百分比、捐赠服务区的种族构成，以及接受者必须前往移植的距离。非西班牙裔黑人被列入肝脏移植名单的人数低于预期。然而，一旦被列入名单，移植中的种族差异就会大大减少。改善获得适当医疗保险的机会似乎对缩小获得这种挽救生命的护理方面的差距至关重要。
Previous studies have demonstrated disparities in transplantation for women, non-Caucasians, the uninsured or publicly insured, and rural populations. We sought to correlate transplant center characteristics with patient access to the waiting list and liver transplantation. We hypothesized that liver transplant centers vary greatly in providing equitable access to the waiting list and liver transplantation. Center-specific, adult, deceased-donor liver transplant and waitlist data for the years 2013 to 2018 were obtained from the United Network for Organ Sharing. Waitlist race/ethnicity distributions from liver transplant centers performing ≥ 250 transplants over this period (n = 109) were compared with those of their donor service area, as calculated from 5-year US Census Bureau estimates of 2017. Center-specific characteristics correlating with disparities were analyzed using a linear regression model with a log transformed outcome. Non-Hispanic Blacks (NHBs) are under-represented in liver transplant listing compared with center donation service area (88/109, 81%), whereas, non-Hispanic Whites are over-represented (65/109, 58%) (p < 0.0001). Hispanics were also under-represented on the waitlist at the majority of transplant centers (68/109, 62%) (p = 0.02). Although the racial/ethnic distribution of transplantation is more reflective of the waitlist, there is a higher than expected rate of transplantation for NHBs compared to the waitlist. Predictors of disparity in listing include percentage of transplant recipients at the center who had private insurance, racial composition of the donation service area, and the distance recipients had to travel for transplant. Non-Hispanic Blacks are listed for liver transplantation less than would be expected. Once listed, however, racial disparities in transplantation are greatly diminished. Improvements in access to adequate health insurance appear to be essential to diminishing disparities in access to this life-saving care.
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影响因子：
3.8
作者：
Ballestri S;Nascimbeni F;Baldelli E;Marrazzo A;Romagnoli D;Lonardo A
通讯作者：
Lonardo A
影响因子：
13.5
作者：
Browning, JD;Szczepaniak, LS;Hobbs, HH
通讯作者：
Hobbs, HH
影响因子：
6.2
作者：
Lucey, M R;Brown, K A;Wiesner, R H
通讯作者：
Wiesner, R H
影响因子：
13.8
作者：
Gutin, Liat;Yao, Francis;Mehta, Neil
通讯作者：
Mehta, Neil
影响因子：
8.8
作者：
Bryce, C. L.;Angus, D. C.;Roberts, M. S.
通讯作者：
Roberts, M. S.