title: Disparities in access to lung transplantation for patients with cystic fibrosis by socioeconomic status.
abstract: BACKGROUND
  Although previous studies suggest that access to care for patients with cystic fibrosis (CF) does not vary appreciably by socioeconomic status (SES), disparities with respect to access to lung transplantation for patients with CF are largely unknown.
  
  
  OBJECTIVE
  To determine whether access to lung transplantation for patients with CF differs according to SES.
  
  
  METHODS
  Observational study involving 2,167 adult patients with CF from the CF Foundation Patient registry who underwent their first lung transplant evaluation between 2001 and 2009. The primary outcome was acceptance for lung transplant after initial evaluation. The main SES indicator was Medicaid status. Alternate SES indicators included race, educational attainment, ZIP code-level median household income, and driving time from residence to closest lung transplant center.
  
  
  RESULTS
  The odds that Medicaid recipients were not accepted for lung transplant were 1.56-fold higher (95% confidence interval [CI], 1.27-1.92) than patients without Medicaid, after multivariate adjustment for demographic characteristics, disease severity, and potential contraindications to lung transplant, and before or after use of the lung allocation score. This association was independent of other SES indicators, including race, educational attainment, ZIP code-level median household income, and driving time to closest transplant center (odds ratio [OR] = 1.37; 95% CI, 1.10-1.72). Patients not completing high school (OR = 2.37; 95% CI, 1.49-3.79) and those residing in the lowest (vs. highest) ZIP code median household income category (OR = 1.39; 95% CI, 1.01-1.93) also experienced a higher odds of not being accepted for lung transplant in multivariate analysis.
  
  
  CONCLUSIONS
  In this nationally representative study of adult patients with CF, multiple indicators of low SES were associated with higher odds of not being accepted for lung transplant.
authors.affiliation: University of Washington Medical Center, BB-1327, 1959 NE Pacific Street, Seattle, WA 98195, USA. bquon@uw.edu
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Quon
authors.forename: Kevin
authors.initials: K
authors.lastname: Psoter
authors.forename: Nicole
authors.initials: N
authors.lastname: Mayer-Hamblett
authors.forename: Moira L
authors.initials: ML
authors.lastname: Aitken
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Li
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Goss
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000601:surgery*; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D016040:Lung Transplantation; D008297:Male; D008484:Medicaid; D044469:Racial Groups; D012923:Social Class; D014481:United States