Cystic fibrosis patients of low SES are less likely to be accepted for lung transplant
Adult cystic fibrosis (CF) patients of low socioeconomic status (SES) have a greater chance of not being accepted for lung transplant after undergoing initial evaluation, according to a new study.
“While earlier studies have indicated that SES does not affect access to care for cystic fibrosis, ours is the first study to examine the relationship between SES and access to lung transplantation in these patients,” said lead author Bradley S. Quon, MD, MSc, MBA, of the University of Washington Medical Center in Seattle. “In our nationally representative sample of adult patients with CF, we found that multiple indicators of SES were associated with greater odds of not being accepted for transplant.”
The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.
The study included 2,167 adult CF patients from the CF Foundation Patient registry, all of whom underwent their first lung transplant evaluation as an adult between January 1, 2001, and December 31, 2009. Receipt of Medicaid insurance was used as the primary indicator of SES status. The outcome of interest was acceptance onto the waiting list for lung transplant after initial evaluation. Patients who were either declined or deferred were classified as not accepted, and an additional sensitivity analysis was performed based on the final decision of whether a patient was accepted or declined at the end of the study period.
Of the 2,167 patients included in the study, 1009 (47%) received Medicaid. Compared to non-Medicaid patients, the odds of not being accepted for lung transplant was 1.56 fold higher among Medicaid recipients. This relationship was independent of differences in disease severity, demographic factors, contraindications to lung transplant, and use of the lung allocation score.
Other indicators of low SES, including residing in lower income zip codes and not graduating from high school, were also independently associated with not being accepted for lung transplant after undergoing initial evaluation.
What is Cystic Fibrosis?
- Cystic Fibrosis (CF) is one of the UK’s most common life-threatening inherited diseases.
- It is caused by a faulty gene that controls the movement of salt and water in and out of the cells within the body.
- Cystic Fibrosis affects the internal organs, especially the lungs and digestive system, by clogging them with thick sticky mucus. This makes it hard to breathe and digest food.
- Over 9,000 people in the UK have Cystic Fibrosis.
- If two carriers have a child, the baby has a 1 in 4 chance of having Cystic Fibrosis.
- Over two million people in the UK carry the faulty gene that causes Cystic Fibrosis - around 1 in 25 of the population.
- Over 95% of the UK CF population is Caucasian, but CF affects many ethnic groups.
- Each week, five babies are born with Cystic Fibrosis.
- Each week, two young lives are lost to Cystic Fibrosis.
- Currently half of the CF population will live past 41 years of age, and improvements in treatments mean a baby born today is expected to live even longer.
The study had a few limitations, including the use of Medicaid and other indicators as proxies for SES status. Furthermore, inadequate social support and poor adherence are key determinants of transplant eligibility. Although the authors attempted to account for these factors in their analysis, incomplete adjustment for these variables may at least partially explain why low SES was associated with not being accepted for lung transplant.
“The results of our study are concerning, as the effects of SES status on access to lung transplant appear to be unrelated to differences in disease severity or potential contraindications,” said Dr. Quon. “More research is needed to explore the factors associated with Medicaid status that negatively impact lung transplant access and to assess whether these disparities are seen in other pre-lung transplant patient populations.”
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About the American Journal of Respiratory and Critical Care Medicine:
With an impact factor of 11.080, the AJRRCM is a peer-reviewed journal published by the American Thoracic Society. It aims to publish the most innovative science and the highest quality reviews, practice guidelines and statements in the pulmonary, critical care and sleep-related fields.
Founded in 1905, the American Thoracic Society is the world’s leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society’s 15,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy.
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Nathaniel Dunford
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212-315-8620
American Thoracic Society