Racial differences in waiting list outcomes in chronic obstructive pulmonary disease.
BACKGROUND
Blacks with chronic illness have poorer outcomes than whites in the United States. The health outcomes of minorities with chronic obstructive pulmonary disease (COPD) on the lung transplant waiting list have not been studied.


OBJECTIVE
To compare outcomes of black and white patients with COPD after listing for lung transplantation in the United States.


METHODS
Retrospective cohort study of all 280 non-Hispanic black and 5,272 non-Hispanic white adults 40 years and older with COPD listed for lung transplantation in the United States between 1995 and 2004.


RESULTS
Blacks with COPD were more likely to have pulmonary hypertension, obesity, and diabetes; to lack private health insurance; and to live in poorer neighborhoods than whites. Blacks were less likely to undergo transplantation after listing compared with whites, despite adjustment for age, lung function, pulmonary hypertension, cardiovascular risk factors, insurance coverage, and poverty level (adjusted hazard ratio, 0.83; 95% confidence interval, 0.70-0.98; P = 0.03). This was accompanied by a greater risk of dying or being removed from the list among blacks (unadjusted hazard ratio, 1.31; 95% confidence interval, 1.05-1.63; P = 0.02).


CONCLUSIONS
After listing for lung transplantation, black patients with COPD were less likely to undergo transplantation and more likely to die or be removed from the list compared with white patients. Unequal access to care may have contributed to these differences.
Lederer
David J
DJ
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH-8, Room 101, New York, NY 10032, USA. dl427@columbia.edu
Benn
Emma K T
EK
Barr
R Graham
RG
Wilt
Jessie S
JS
Reilly
Genevieve
G
Sonett
Joshua R
JR
Arcasoy
Selim M
SM
Kawut
Steven M
SM
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D016040:Lung Transplantation / Q000208:ethnology* / Q000706:statistics & numerical data; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000208:ethnology* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data*