title: Variation in access to the liver transplant waiting list in the United States.
abstract: BACKGROUND
  We sought to compare liver transplant waiting list access by demographics and geography relative to the pool of potential liver transplant candidates across the United States using a novel metric of access to care, termed a liver wait-listing ratio (LWR).
  
  
  METHODS
  We calculated LWRs from national liver transplant registration data and liver mortality data from the Scientific Registry of Transplant Recipients and the National Center for Healthcare Statistics from 1999 to 2006 to identify variation by diagnosis, demographics, geography, and era.
  
  
  RESULTS
  Among patients with ALF and CLF, African Americans had significantly lower access to the waiting list compared with whites (acute: 0.201 versus 0.280; pre-MELD 0.201 versus 0.290; MELD era: 0.201 versus 0.274; all, P<0.0001) (chronic: 0.084 versus 0.163; pre-MELD 0.085 versus 0.179; MELD 0.084 versus 0.154; all, P<0.0001). Hispanics and whites had similar LWR in both eras (both P>0.05). In the MELD era, female subjects had greater access to the waiting list compared with male subjects (acute: 0.428 versus 0.154; chronic: 0.158 versus 0.140; all, P<0.0001). LWRs varied by three-fold by state (pre-MELD acute: 0.122-0.418, chronic: 0.092-0.247; MELD acute: 0.121-0.428, chronic: 0.092-0.243).
  
  
  CONCLUSIONS
  The marked inequity in early access to liver transplantation underscores the need for local and national policy initiatives to affect this disparity.
authors.affiliation: 1 Department of Surgery, University of Michigan Ann Arbor, MI. 2 Department of Biostatistics, University of Michigan Ann Arbor, MI. 3 Kidney Epidemiology and Cost Center, University of Michigan Ann Arbor, MI. 4 Arbor Research Collaborative for Health, Ann Arbor, MI. 5 Department of Medicine, University of Michigan Ann Arbor, MI. 6 Address correspondence to: Amit K. Mathur, M.D., M.S., 2922 Taubman Center, SPC 5300, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5300.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
authors.forename: Valarie B
authors.initials: VB
authors.lastname: Ashby
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Fuller
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
authors.forename: Alan
authors.initials: A
authors.lastname: Leichtman
authors.forename: John
authors.initials: J
authors.lastname: Kalbfleisch
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D005260:Female; D015276:Health Care Rationing / Q000639:trends; D006297:Health Services Accessibility / Q000639:trends*; D006301:Health Services Needs and Demand / Q000639:trends; D054625:Healthcare Disparities / Q000208:ethnology / Q000639:trends*; D006630:Hispanic or Latino; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000639:trends*; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality; D044465:White People; D055815:Young Adult