University of Washington Medical Center, BB-1327, 1959 NE Pacific Street, Seattle, WA 98195, USA.
Am J Respir Crit Care Med. 2012 Nov 15;186(10):1008-13. doi: 10.1164/rccm.201205-0949OC. Epub 2012 Sep 13.
Although previous studies suggest that access to care for patients with cystic fibrosis (CF) does not vary appreciably by socioeconomic status (SES), disparities with respect to access to lung transplantation for patients with CF are largely unknown.
To determine whether access to lung transplantation for patients with CF differs according to SES.
Observational study involving 2,167 adult patients with CF from the CF Foundation Patient registry who underwent their first lung transplant evaluation between 2001 and 2009. The primary outcome was acceptance for lung transplant after initial evaluation. The main SES indicator was Medicaid status. Alternate SES indicators included race, educational attainment, ZIP code-level median household income, and driving time from residence to closest lung transplant center.
The odds that Medicaid recipients were not accepted for lung transplant were 1.56-fold higher (95% confidence interval [CI], 1.27-1.92) than patients without Medicaid, after multivariate adjustment for demographic characteristics, disease severity, and potential contraindications to lung transplant, and before or after use of the lung allocation score. This association was independent of other SES indicators, including race, educational attainment, ZIP code-level median household income, and driving time to closest transplant center (odds ratio [OR] = 1.37; 95% CI, 1.10-1.72). Patients not completing high school (OR = 2.37; 95% CI, 1.49-3.79) and those residing in the lowest (vs. highest) ZIP code median household income category (OR = 1.39; 95% CI, 1.01-1.93) also experienced a higher odds of not being accepted for lung transplant in multivariate analysis.
In this nationally representative study of adult patients with CF, multiple indicators of low SES were associated with higher odds of not being accepted for lung transplant.
尽管先前的研究表明，囊性纤维化（CF）患者的医疗服务获取情况在社会经济地位（SES）方面差异不大，但 CF 患者接受肺移植服务的机会是否存在差异尚不清楚。
确定 CF 患者接受肺移植的机会是否因 SES 而异。
本观察性研究纳入了 2167 名来自 CF 基金会患者登记处的成年 CF 患者，这些患者在 2001 年至 2009 年间接受了首次肺移植评估。主要结局是初次评估后接受肺移植。主要 SES 指标是医疗补助状况。替代 SES 指标包括种族、教育程度、ZIP 码层面的家庭中位收入和居住地到最近肺移植中心的驾车时间。
多变量调整了人口统计学特征、疾病严重程度和肺移植潜在禁忌证后，医疗补助受助人未被接受肺移植的几率是未接受医疗补助者的 1.56 倍（95%置信区间[CI]，1.27-1.92），并且在使用肺分配评分之前或之后也是如此。这种关联独立于其他 SES 指标，包括种族、教育程度、ZIP 码层面的家庭中位收入和到最近移植中心的驾车时间（比值比[OR] = 1.37；95% CI，1.10-1.72）。未完成高中学业的患者（OR = 2.37；95% CI，1.49-3.79）和居住在收入最低（而非最高）ZIP 码家庭中位收入类别的患者（OR = 1.39；95% CI，1.01-1.93）在多变量分析中也更有可能未被接受肺移植。
在这项针对成年 CF 患者的全国代表性研究中，多种 SES 低指标与未被接受肺移植的几率增加相关。
