Journal article
Rates of solid-organ wait-listing, transplantation, and survival among residents of rural and urban areas
JAMA : the journal of the American Medical Association, Vol.299(2), pp.202-207
01/09/2008
DOI: 10.1001/jama.2007.50
PMID: 18182602
Abstract
Context Disparities in access to organ transplantation exist for racial minorities, women, and patients with lower socioeconomic status or inadequate insurance. Rural residents represent another group that may have impaired access to transplant services.
Objective To assess the association of rural residence with waiting list registration for heart, liver, and kidney transplant and rates of transplantation among wait- listed candidates.
Design, Setting, and Patients Five- year US cohort of 174 630 patients who were wait- listed and who underwent heart, liver, or kidney transplantation between 1999 and 2004.
Main Outcome Measures Rates of new waiting list registrations and transplants per million population for residents of 3 residential classifications ( rural/ small town population, < 10 000; micropolitan, 10 000- 50 000; and metropolitan > 50 000 or suburb of major city).
Results Compared with urban residents, waiting list registration rates for rural/ small town residents were significantly lower for heart ( covariate- adjusted rate ratio [ RR]= 0.91; 95% confidence interval [ Cl], 0.86- 0.96; P <. 002), liver ( RR= 0.86; 95% Cl, 0.83- 0.89; P <. 001), and kidney transplants ( RR= 0.92; 95% Cl, 0.90- 0.95; P <. 001). Compared with residents in urban areas, rural/ small town residents had lower relative transplant rates for heart ( RR= 0.88; 95% Cl, 0.81- 0.94; P=. 004), liver ( RR= 0.80; 95% Cl, 0.77- 0.84; P < .001), and kidney transplantation ( covariate- adjusted RR= 0.90; 95% Cl, 0.88- 0.93; P <. 001). These disparities were consistent across national organ allocation regions. Significantly longer waiting times among rural patients wait- listed for heart transplantation were observed but not for liver and kidney transplantation. There were no significant differences in posttransplantation outcomes between groups.
Conclusions Patients living in rural areas had a lower rate of wait- lisiting and transplant of solid organs, but did not experience significantly different outcomes following transplant. Differences in rates of wait- listing and transplant may be due to variations in the burden of disease between different patient groups or barriers to evaluation and waiting list entry for rural residents with organ failure.
Details
- Title: Subtitle
- Rates of solid-organ wait-listing, transplantation, and survival among residents of rural and urban areas
- Creators
- David A. Axelrod - Dartmouth CollegeMary K. Guidinger - Scientific Registry of Transplant RecipientsSamuel Finlayson - Dartmouth–Hitchcock Medical CenterDouglas E. Schaubel - Biostatistical ConsultingDavid C. Goodman - Dartmouth CollegeMichael Chobanian - Dartmouth CollegeRobert M. Merion - University of Michigan–Ann Arbor
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.299(2), pp.202-207
- Publisher
- Amer Medical Assoc
- DOI
- 10.1001/jama.2007.50
- PMID
- 18182602
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Number of pages
- 6
- Grant note
- 234-2005-37009C / PHS HHS; United States Department of Health & Human Services; United States Public Health Service
- Language
- English
- Date published
- 01/09/2008
- Academic Unit
- Surgery
- Record Identifier
- 9984322953102771
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