التفاصيل البيبلوغرافية
| العنوان: |
Insurance status is an independent predictor of long-term survival after lung transplantation in the United States |
| المؤلفون: |
Allen, Jeremiah G.1, Arnaoutakis, George J.1, Orens, Jonathan B.2, McDyer, John2, Conte, John V.1, Shah, Ashish S.1, Merlo, Christian A.2 cmerlo@jhmi.edu |
| المصدر: |
Journal of Heart & Lung Transplantation. Jan2011, Vol. 30 Issue 1, p45-53. 9p. |
| مصطلحات موضوعية: |
*LUNG transplantation, *HEALTH insurance, *SOCIOECONOMIC factors, *HEALTH outcome assessment, *RETROSPECTIVE studies, *MORTALITY, *PROPORTIONAL hazards models |
| مصطلحات جغرافية: |
UNITED States |
| مستخلص: |
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. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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