Impact of Payer Status on Delisting Among Liver Transplant Candidates in the United States.
Publication Title
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Document Type
Article
Publication Date
11-13-2020
Keywords
diversity/inclusion
Abstract
BACKGROUND: While socioeconomic disparities persist both pre- and post-transplantation, the impact of payer status has not been studied at the national level. We examined the association between public insurance coverage and waitlist outcomes among candidates listed for liver transplantation (LT) in the United States.
METHODS: All adults (≥18 years) listed for LT between 2002-2018 in the United Network for Organ Sharing (UNOS) database were included. The primary outcome was waitlist removal due to death or clinical deterioration. Continuous and categorical variables were compared using the Kruskal-Wallis and chi-squared tests, respectively. Fine and Gray competing-risks regression was used to estimate sub-distribution hazard ratios for risk factors associated with delisting.
RESULTS: Of 131,839 patients listed for LT, 61.2% were covered by private insurance, 22.9% by Medicare and 15.9% by Medicaid. The one-year cumulative incidence of delisting was 9.0% (95% CI: [8.3%-9.8%]) for patients with private insurance, 10.7% [9.9%-11.6%] for Medicare and 10.7% [9.8%-11.6%] for Medicaid. In multivariable competing-risks analysis, Medicare (HR 1.20 [1.17-1.24], p
CONCLUSIONS: In this study, LT candidates with Medicare or Medicaid had 20% increased risk of delisting due to death or clinical deterioration than those with private insurance. As more patients use public insurance to cover the cost of LT, targeted waitlist management protocols may mitigate the increased risk of delisting in this population.
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Hepatology
Specialty/Research Institute
Surgery
