■肝移植(LT)后的存活率受多种因素的影响,包括供体风险因素和受体疾病负担和合并症。很难将这些影响与社会经济因素的影响分开,比如收入或保险。器官共享联合网络(UNOS)制定了公平的获取政策,例如Share35,以确保将器官分发给医疗需求最大的个人;但是,份额35对LT后生存差异的影响尚不清楚。这项研究旨在(1)描述移植后生存与种族和民族之间的关联,收入,保险,和公民身份,当调整其他可能影响生存的临床和人口统计学因素时,以及(2)确定35号股后关联方向是否发生变化。
■回顾,从2005年至2019年,对UNOS数据库中的成年LT接受者(n=83,254)进行了队列研究。进行了Kaplan-Meier生存图和逐步多变量cox回归分析,以表征社会经济地位对LT后生存的影响。根据接受者和捐赠者的特征进行调整,在整个时间段和分享35之后。
■男性(HR:0.93(95%CI:0.90-0.96)),私人保险(0.91(0.88-0.94)),收入(0.82(0.79-0.85)),美国公民身份,亚裔(0.81(0.75-0.88))或西班牙裔(0.82(0.79-0.86))种族和种族与较高的移植后生存率相关,在调整临床和人口统计学因素后(表3)。在研究的整个时间段内都发现了这些关联,并且在2013年实施了Share35之后仍然存在许多关联(表3;男性(0.84(0.79-0.90)),私人保险(0.94(0.89-1.00)),收入(0.82(0.77-0.89)),和亚洲(0.87(0.73-1.02))或西班牙裔(0.88(0.81-0.96))种族和种族)。
■受者移植时的社会经济因素可能会影响移植后的长期生存,单一政策可能不会显著改变这些结构性健康不平等。
■无。
UNASSIGNED: Survival following liver transplant (LT) is influenced by a variety of factors, including donor risk factors and recipient disease burden and co-morbidities. It is difficult to separate these effects from those of socioeconomic factors, such as income or insurance. The United Network for Organ Sharing (UNOS) created equitable access policies, such as Share 35, to ensure that organs are distributed to individuals with greatest medical need; however, the effect of Share 35 on disparities in post-LT survival is not clear. This study aimed to (1) characterize associations between post-transplant survival and race and ethnicity, income, insurance, and citizenship status, when adjusted for other clinical and demographic factors that may influence survival, and (2) determine if the direction of associations changed after Share 35.
UNASSIGNED: A retrospective, cohort study of adult LT recipients (n = 83,254) from the UNOS database from 2005 to 2019 was conducted. Kaplan-Meier survival graphs and stepwise multivariate cox-regression analyses were performed to characterize the effects of socioeconomic status on post-LT survival, adjusted for recipient and donor characteristics, across the time period and after Share 35.
UNASSIGNED: Male sex (HR: 0.93 (95% CI: 0.90-0.96)), private insurance (0.91 (0.88-0.94)), income (0.82 (0.79-0.85)), U.S. citizenship, and Asian (0.81 (0.75-0.88)) or Hispanic (0.82 (0.79-0.86)) race and ethnicity were associated with higher post-transplant survival, after adjustment for clinical and demographic factors (Table 3). These associations were found across the entire time period studied and many persisted after the implementation of Share 35 in 2013 (Table 3; male sex (0.84 (0.79-0.90)), private insurance (0.94 (0.89-1.00)), income (0.82 (0.77-0.89)), and Asian (0.87 (0.73-1.02)) or Hispanic (0.88 (0.81-0.96)) race and ethnicity).
UNASSIGNED: Recipients\' socioeconomic factors at time of transplant may impact long-term post-transplant survival, and a single policy may not significantly alter these structural health inequalities.
UNASSIGNED: None.