Patient Travel Distance and Post Lung Transplant Survival in the United States: A Cohort Study

Abstract

Background. In response to a longstanding Federal mandate to minimize the role of geography in access to transplant in the United States, we assessed whether patient travel distance was associated with lung transplant outcomes. We focused on the posttransplant time period, when the majority of patient visits to a transplant center occur. Methods. We present a cohort study of lung transplants in the United States between January 1, 2006, and May 31, 2017. Travel distance was measured from the patient’s permanent home zip code to the transplant center using SAS URL access to GoogleMaps. We leveraged data from the US Census, US Department of Agriculture, and the Economic Innovations Group to assess socioeconomic status. Multivariable Cox models were used to assess graft survival. Results. We included 18 128 patients who met the inclusion criteria. Median distance was 69.6 miles. Among patients who traveled >60 miles to reach a transplant center, 41.8% bypassed a closer center and sought care at a more distant center. Patients traveling longer distances sought care at centers with a higher annual transplant volume. In the adjusted Cox Model, patients who traveled >360 miles had a slightly higher risk for posttransplant graft failure than patients traveling ≤60 miles (hazard ratio 1.09; 95% CI, 1.01-1.18), and a higher risk for treated acute rejection (hazard ratio, 1.63; 95% CI, 1.43-1.86). Conclusions Travel distance was significantly associated with post lung transplant survival. However, this effect was relatively modest. Patient travel distance is an important component of access to lung transplant care.

Impact of distance from implant center on mechanical circulatory device patient outcomes

“…They found that distant travelers had better outcomes compared to nontravelers 14 . In a retrospective single‐center study, Tsuang et al 15 found no significant relationship between recipient travel distance and post lung transplant graft survival. They concluded that in carefully selected recipients, travel distance is not a significant barrier to successful posttransplant outcomes.…”

Place-based heterogeneity in lung transplant recipient outcomes

“…The LAS is a quantitative measure of medical urgency used to prioritize waitlisted patients using over a dozen clinical variables 21 . Patient driving distance was calculated using the methods we have previously described 22 . We also assessed whether a national policy shift toward broader geographic sharing of donor's lungs during the study period 23 impacted our results (pre‐ vs. post‐November 2017).…”

“…21 Patient driving distance was calculated using the methods we have previously described. 22 We also assessed whether a national policy shift toward broader geographic sharing of donor's lungs during the study period 23 impacted our results (pre-vs. post-November 2017).…”

Lung transplant waitlist outcomes in the United States and patient travel distance

“…This study was declared exempt by the Cleveland Clinic Institutional Review Board (19‐1432). Portions of this study were presented at the American Transplant Congress, 10 and our approach using Google Maps has been described in a separate publication on posttransplant outcomes 11 …”

“…Portions of this study were presented at the American Transplant Congress, 10 and our approach using Google Maps has been described in a separate publication on posttransplant outcomes. 11 We linked the SRTR with additional registries to include the median annual income for each zip code as captured by the US Census, 12 the metro population size from the US Department of Agriculture, 13 and the Distressed Communities Index (DCI) from the Economic Innovation Group. 14 The DCI combines metrics such as unemployment, education level, poverty rate, median income, and housing vacancies in order to calculate an index score for each zip code from 0 (no distress) to 100 (severe distress).…”