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

Jeremiah G. Allen, George J. Arnaoutakis, Jonathan B. Orens, John McDyer, John V. Conte, Ashish S. Shah, Christian A. Merlo

Research output: Contribution to journalArticle

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 (19982008). 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, 1.031.19) and Medicaid (hazard ratio, 1.29; 95% confidence interval, 1.151.45) 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.

Original languageEnglish (US)
Pages (from-to)45-53
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number1
DOIs
StatePublished - Jan 1 2011

Keywords

  • education
  • insurance
  • lung transplantation
  • outcomes
  • socioeconomic factors

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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