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J Heart Lung Transplant. 2011 Jan;30(1):45-53. doi: 10.1016/j.healun.2010.07.003.

Insurance status is an independent predictor of long-term survival after lung transplantation in the United States.

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  • 1Department of Surgery, Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.

Abstract

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.

Copyright © 2011 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

PMID:
20869264
[PubMed - indexed for MEDLINE]
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