Socioeconomic Disparities in Adherence and Outcomes After Heart Transplant

Abstract

Racial and socioeconomic disparities exist in heart transplant outcomes, but the latter may be narrowing over time. These disparities are not explained by differences in clinical or graft characteristics.

The impact of insurance type on listing status and wait‐list mortality of patients with left ventricular assist devices as bridge to transplantation

“…Patients at lower socio‐economic status are more likely Medicare or Medicaid beneficiaries and less likely privately insured . Furthermore, the recent analysis of UNOS registry on 33 893 adult heart transplant recipients between 1994 and 2014 suggested increased risk of death or retransplantation associated with public health insurance status . Among patients younger than 65 years, Medicare coverage has increased significantly during the past 20 years to approximately 30%, whereas Medicaid coverage rates have remained stable and private insurance coverage has decreased, similar to the findings of our analysis .…”

“…Furthermore, the recent analysis of UNOS registry on 33 893 adult heart transplant recipients between 1994 and 2014 suggested increased risk of death or retransplantation associated with public health insurance status . Among patients younger than 65 years, Medicare coverage has increased significantly during the past 20 years to approximately 30%, whereas Medicaid coverage rates have remained stable and private insurance coverage has decreased, similar to the findings of our analysis . The reason for increased Medicare coverage is the eligibility of an increasing number of stage D heart failure patients for long‐term disability benefits (at least 2 years).…”

“…Socio‐economic disparities exist among HT recipients and affect outcomes post transplantation. Patients at lower socio‐economic status are more likely Medicare or Medicaid beneficiaries and less likely privately insured . Furthermore, the recent analysis of UNOS registry on 33 893 adult heart transplant recipients between 1994 and 2014 suggested increased risk of death or retransplantation associated with public health insurance status .…”

Mitigating the Impact of Socioeconomic Status on Listing for Lung Transplantation in Cystic Fibrosis

“…In other lung diseases, minority patients with idiopathic pulmonary fibrosis or chronic obstructive pulmonary disease on the lung transplant waiting list are less likely to survive to transplant ( 12 , 13 ). In another thought-provoking article exploring survival differences between Canada and the United States in patients with CF, the presence of Medicaid or Medicare insurance had a detrimental effect on survival for patients in the United States, even though these programs offer services that have similarities to the Canadian universal health insurance system ( 14 ); this is possibly another sign of poor socioeconomic status influencing outcomes in CF.…”

Utilizing gene expression profiling to understand immunologic mechanisms that impact racial disparities after heart transplant

“…These data confirm that explanations for racial differences in outcomes, such as differences in access to care and socioeconomic status, are no longer adequate, as multiple studies demonstrate that the racial disparity persists after adjusting for a wide array of socioeconomic factors and comorbidities. 2,17 If we consider current HT waitlist trends showing the proportion of black HT candidates has increased over the past decade (blacks comprised 25.5% of patients awaiting HT and 23.8% of organ recipients in 2017 1 ), there are real and immediate consequences to our lack of understanding of the immunologic phenomena driving worse outcomes in black HT recipients. An increasing volume of HT recipients who are race/ethnic minorities will translate into worse clinical outcomes for the entire HT community over the coming decades, and worse outcomes in particular for centers that serve a larger number of such minorities.…”