title: Racial disparities in survival after lung transplantation.
abstract: BACKGROUND
  Racial disparities have not been comprehensively evaluated among recipients of lung transplantation.
  
  
  OBJECTIVE
  To describe the association between race and lung transplant survival and to determine whether racial disparities have changed in the modern (2001-2009) compared with the historical (1987-2000) transplant eras.
  
  
  METHODS
  A retrospective cohort study of 16 875 adults who received primary lung transplants from October 16, 1987, to February 19, 2009, was conducted using data from the United Network of Organ Sharing.
  
  
  METHODS
  We measured the risk of death after lung transplant for nonwhites compared with whites using time-to-event analysis.
  
  
  RESULTS
  During the study period, 14 858 white and 2017 nonwhite patients underwent a lung transplant; they differed significantly at baseline. The percentage of nonwhite transplant recipients increased from 8.8% (before 1996) to 15.0% (2005-2009). In the historical era, 5-year survival was lower for nonwhites than whites (40.9% vs 46.9%). Nonwhites were at an increased risk of death independent of age, health and socioeconomic status, diagnosis, geographic region, donor organ characteristics, and operative factors (hazard ratio, 1.15; 95% confidence interval, 1.01-1.30). In subgroup analysis of the historical era, blacks had worsened 5-year survival compared with whites (39.0% vs 46.9%) and black women had worsened survival compared with white women (36.9% vs 48.9%). In the modern transplant era, survival improved for all patients. However, a greater improvement among nonwhites has eliminated the disparities in survival between the races (5-year survival, 52.5% vs 51.6%).
  
  
  CONCLUSIONS
  In contrast to the historical era, there was no significant difference in lung transplant survival in the modern era between whites and nonwhites.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA. vinliu@stanford.edu
authors.forename: Vincent
authors.initials: V
authors.lastname: Liu
authors.forename: David
authors.initials: D
authors.lastname: Weill
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000208:ethnology* / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data