Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Am J Transplant. 2021 Jan;21(1):272-280. doi: 10.1111/ajt.16193. Epub 2020 Aug 5.
There is a broad range of patient travel distances to reach a lung transplant hospital in the United States. Whether patient travel distance is associated with waitlist outcomes is unknown. We present a cohort study of patients listed between January 1, 2006 and May 31, 2017 using the Scientific Registry of Transplant Recipients. Travel distance was measured from the patient's permanent zip code to the transplant hospital using shared access signature URL access to Google Maps, and assessed using multivariable competing risk regression models. There were 22 958 patients who met inclusion criteria. Median travel distance was 69.7 miles. Among patients who traveled > 60 miles, 41.2% bypassed a closer hospital and sought listing at a more distant hospital. In the adjusted models, when compared to patients who traveled ≤60 miles, patients who traveled >360 miles had a 27% lower subhazard ratio (SHR) for waitlist removal (SHR 0.73, 95% confidence interval [CI]: 0.60, 0.89, P = .002), 16% lower subhazard for waitlist death (SHR 0.84; 95% CI 0.73-0.95, P = .07), and 13% increased likelihood for transplant (SHR 1.13, 95% CI: 1.07, 1.20, P < .001). Many patients bypassed the nearest transplant hospital, and longer patient travel distance was associated with favorable waitlist outcomes.
在美国，患者前往肺移植医院的距离范围很广。患者旅行距离是否与候补名单结果有关尚不清楚。我们使用移植受者科学登记处对 2006 年 1 月 1 日至 2017 年 5 月 31 日期间列出的患者进行了队列研究。使用共享访问签名 URL 访问谷歌地图，从患者的永久邮政编码到移植医院测量旅行距离，并使用多变量竞争风险回归模型进行评估。共有 22958 名符合纳入标准的患者。中位数旅行距离为 69.7 英里。在旅行>60 英里的患者中，41.2%绕过了更近的医院，选择在更远的医院接受登记。在调整后的模型中，与旅行≤60 英里的患者相比，旅行>360 英里的患者等待名单移除的亚危险比（SHR）降低了 27%（SHR 0.73，95%置信区间[CI]：0.60，0.89，P=0.002），等待名单死亡的亚危险比（SHR 0.84；95%CI 0.73-0.95，P=0.07）降低了 16%，而移植的可能性增加了 13%（SHR 1.13，95%CI：1.07，1.20，P<0.001）。许多患者绕过了最近的移植医院，而患者的旅行距离较长与有利的候补名单结果相关。
