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.
Keywords
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Article info
Publication history
Published online: September 28, 2010
Identification
Copyright
© 2011 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
