Bryce C L, Angus D C, Arnold R M, Chang C-C H, Farrell M H, Manzarbeitia C, Marino I R, Roberts M S
Division of General Internal Medicine, Department of Medicine, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Am J Transplant. 2009 Sep;9(9):2092-101. doi: 10.1111/j.1600-6143.2009.02737.x. Epub 2009 Jul 23.
The question of whether health care inequities occur before patients with end-stage liver disease (ESLD) are waitlisted for transplantation has not previously been assessed. To determine the impact of gender, race and insurance on access to transplantation, we linked Pennsylvania sources of data regarding adult patients discharged from nongovernmental hospitals from 1994 to 2001. We followed the patients through 2003 and linked information to records from five centers responsible for 95% of liver transplants in Pennsylvania during this period. Using multinomial logistic regressions, we estimated probabilities that patients would undergo transplant evaluation, transplant waitlisting and transplantation itself. Of the 144,507 patients in the study, 4361 (3.0%) underwent transplant evaluation. Of those evaluated, 3071 (70.4%) were waitlisted. Of those waitlisted, 1537 (50.0%) received a transplant. Overall, 57,020 (39.5%) died during the study period. Patients were less likely to undergo evaluation, waitlisting and transplantation if they were women, black and lacked commercial insurance (p < 0.001 each). Differences were more pronounced for early stages (evaluation and listing) than for the transplantation stage (in which national oversight and review occur). For early management and treatment decisions of patients with ESLD to be better understood, more comprehensive data concerning referral and listing practices are needed.
晚期肝病（ESLD）患者在列入移植等候名单之前是否存在医疗保健不平等的问题此前尚未得到评估。为了确定性别、种族和保险对移植可及性的影响，我们将宾夕法尼亚州1994年至2001年非政府医院出院的成年患者的数据来源进行了关联。我们对这些患者随访至2003年，并将信息与在此期间负责宾夕法尼亚州95%肝脏移植的五个中心的记录进行了关联。使用多项逻辑回归，我们估计了患者接受移植评估、列入移植等候名单以及接受移植本身的概率。在该研究的144,507名患者中，4361名（3.0%）接受了移植评估。在接受评估的患者中，3071名（70.4%）被列入等候名单。在被列入等候名单的患者中，1537名（50.0%）接受了移植。总体而言，57,020名（39.5%）患者在研究期间死亡。女性、黑人且缺乏商业保险的患者接受评估、列入等候名单和接受移植的可能性较小（每项p < 0.001）。早期阶段（评估和列入名单）的差异比移植阶段（进行国家监督和审查）更为明显。为了更好地理解ESLD患者的早期管理和治疗决策，需要有关转诊和列入名单做法的更全面数据。
