title: Access to liver transplantation in the MELD era: role of ethnicity and insurance.
abstract: Factors contributing to inequitable access to liver transplantation include socioeconomic status, geographic location, and delayed referral. The aim of this study is to identify the factors associated with a high MELD at the time of listing. Using the UNOS database, we identified all adults listed from 2002 to 2006. Data collected included demographics, insurance payor (private and government, i.e., Medicaid and non-Medicaid), diagnosis, and MELD score categorized as low (<20) and high (>or=20). The results obtained show that a high MELD was associated with age, ethnicity, and insurance (P < 0.001). By multivariate analysis, insurance (OR = 1.21, 95% CI = 1.13-1.30, P < 0.001) and ethnicity (OR = 1.55, 95% CI = 1.28-1.88, P < 0.001) were independently associated with high MELD. In conclusion, ethnic minorities and liver transplant candidates with Medicaid are more likely to have a high MELD score at initial listing. The above results suggest that the type of insurance and ethnicity are independently associated with a high MELD (i.e., sicker patients).
authors.affiliation: University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0595, USA. Nyingi.Kemmer@uc.edu
authors.forename: Nyingi
authors.initials: N
authors.lastname: Kemmer
authors.forename: Victoria
authors.initials: V
authors.lastname: Zacharias
authors.forename: Tiffany E
authors.initials: TE
authors.lastname: Kaiser
authors.forename: Guy W
authors.initials: GW
authors.lastname: Neff
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008107:Liver Diseases / Q000145:classification / Q000191:economics / Q000208:ethnology* / Q000601:surgery*; D016031:Liver Transplantation / Q000191:economics* / Q000208:ethnology*; D008297:Male; D008484:Medicaid / Q000191:economics; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D044469:Racial Groups; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult