Format

Send to

Choose Destination
Am J Kidney Dis. 2018 Feb;71(2):182-190. doi: 10.1053/j.ajkd.2017.08.014. Epub 2017 Nov 8.

Association of Citizenship Status With Kidney Transplantation in Medicaid Patients.

Author information

1
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: jshen@labiomed.org.
2
Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA.
3
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
4
Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
5
Division of Nephrology and Hypertension, University of California Irvine, Orange, CA.
6
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
7
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Abstract

BACKGROUND:

Although individuals classified as nonresident aliens, including undocumented immigrants, are entitled to receive emergency dialysis in the United States regardless of their ability to pay, most states do not provide them with subsidized care for maintenance dialysis or kidney transplantation. We explored whether nonresident aliens have similar outcomes to US citizens after receiving kidney transplants covered by Medicaid, a joint federal and state health insurance program.

STUDY DESIGN:

Retrospective observational cohort study.

SETTING & PARTICIPANTS:

All adult Medicaid patients in the US Renal Data System who received their first kidney transplant from 1990 to 2011.

PREDICTOR:

Citizenship status, categorized as US citizen, nonresident alien, or permanent resident.

OUTCOME:

All-cause transplant loss.

MEASUREMENTS:

HRs and 95% CIs estimated by applying Cox proportional hazards frailty models with transplantation center as a random effect.

RESULTS:

Of 10,495 patients, 8,660 (82%) were US citizens, 1,489 (14%) were permanent residents, and 346 (3%) were nonresident aliens, whom we assumed were undocumented immigrants. Nonresident aliens were younger, healthier, receiving dialysis longer, and more likely to have had a living donor. 71% underwent transplantation in California, and 61% underwent transplantation after 2005. Nonresident aliens had a lower unadjusted risk for transplant loss compared with US citizens (HR, 0.48; 95% CI, 0.35-0.65). Results were attenuated but still significant when adjusted for demographics, comorbid conditions, dialysis, and transplant-related factors (HR, 0.67; 95% CI, 0.46-0.94).

LIMITATIONS:

Citizenship status was self-reported, possible residual confounding.

CONCLUSIONS:

Our study suggests that the select group of insured nonresident aliens who undergo transplantation with Medicaid do just as well as US citizens with Medicaid. Policymakers should consider expanding coverage for kidney transplantation in nonresident aliens, including undocumented immigrants, given the associated high-quality outcomes in these patients.

KEYWORDS:

Kidney transplantation; Medicaid; US health care policy; citizenship; end-stage renal disease (ESRD); immigration; non-resident aliens; transplant outcomes; undocumented immigrants

PMID:
29128413
PMCID:
PMC5794566
[Available on 2019-02-01]
DOI:
10.1053/j.ajkd.2017.08.014

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center