title: Geographic inequity results in disparate mortality: a multivariate intent-to-treat analysis of liver transplant data.
abstract: BACKGROUND
  The distribution of livers to listed transplant candidates shows substantial geographic inequity.
  
  
  OBJECTIVE
  To compare mortality between the 11 UNOS (United Network of Organ Sharing) regions from the time of listing and to show that the geographic region impacts survival.
  
  
  METHODS
  We studied the data of 1930 adults listed with a Model for End-Stage Liver Disease (MELD) score of 18 for a liver transplant from March 1, 2002 through December 31, 2007. We calculated one- and three-yr survival rates and performed multivariate Cox regression analysis to determine significant risk factors for mortality.
  
  
  METHODS
  Patient survival from the time of listing for transplantation.
  
  
  RESULTS
  Actual one-yr mortality rate from the time of listing ranged from 30.5% (Region 2) to 12.9% (Region 4). The three-yr mortality rate ranged from 42.0% (Region 2) to 21.6% (Region 4). Multivariate analysis showed a significant increase in mortality in Region 2 (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.21 to 1.83) and a significant decrease in mortality in Region 3 (OR, 0.74; 95% CI, 0.59 to 0.93).
  
  
  CONCLUSIONS
  We found significant differences in one- and three-yr mortality rates among UNOS regions. Regional disparities significantly affect patient survival and result in national inequality.
authors.affiliation: Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Abbas
authors.initials: A
authors.lastname: Rana
authors.affiliation: Department of Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Irbaz Bin
authors.initials: IB
authors.lastname: Riaz
authors.affiliation: Department of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Angelika C
authors.initials: AC
authors.lastname: Gruessner
authors.affiliation: Division of Abdominal Transplantation, University of Arizona, Tucson, AZ, USA.
authors.forename: Rainer W
authors.initials: RW
authors.lastname: Gruessner
mesh_terms: D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000401:mortality* / Q000601:surgery; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D057194:Intention to Treat Analysis; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists
keywords: geographic inequity; intent-to-treat analysis; liver transplantation