title: Racial disparities in outcomes of adult heart transplantation.
abstract: BACKGROUND
  This study evaluated whether minority orthotopic heart transplant (OHT) recipients tend to be transplanted at worse performing centers.
  
  
  RESULTS
  OHT recipients between 2000 and 2010 were identified in the United Network for Organ Sharing database and stratified by race. Center performance was evaluated using observed-to-expected mortality ratios that were calculated using validated indexes for recipient and donor risk in OHT. The primary outcome was 1-year post-OHT mortality. A total of 102 centers performed OHT in 18 085 patients. Blacks had higher unadjusted 1-year mortality, which was confirmed after risk adjustment. Blacks had increased risk-adjusted mortality at poor performing centers (observed-to-expected mortality ratio, >1.2; odds ratio, 1.37 [95% confidence interval, 1.12-1.69]; P=0.002) and a strong trend toward increased mortality at excellent performing centers (observed-to-expected mortality ratio, <0.8; odds ratio, 1.42 [95% confidence interval, 0.99-2.02]; P=0.06). A higher proportion of blacks were treated at centers with higher-than-expected mortality (56.4% versus 47.1% whites versus 48.1% Hispanics; P<0.001), a finding that persisted after adjusting for insurance type and highest education level. In addition, there was a positive correlation between the percentage of blacks and observed-to-expected mortality ratios at the center level (r=0.32; P=0.001). In multivariable analysis incorporating immunologic and socioeconomic variables, there was no clear dominant source for the disparities in outcomes of OHT between races.
  
  
  CONCLUSIONS
  Blacks have a propensity to be transplanted at worse performing centers; however, center effect alone does not explain the mortality difference between ethnicities. Although referral of minorities to better performing centers would improve absolute survival, it would not likely eliminate the racial disparities that exist in OHT outcomes.
authors: From Department of Surgery, Johns Hopkins Hospital, Baltimore, MD (Arman Kilic); and Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH (R.S.D.H., B.A.W., Ahmet Kilic).
authors: Arman
authors: A
authors: Kilic
authors: From Department of Surgery, Johns Hopkins Hospital, Baltimore, MD (Arman Kilic); and Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH (R.S.D.H., B.A.W., Ahmet Kilic).
authors: Robert S D
authors: RS
authors: Higgins
authors: From Department of Surgery, Johns Hopkins Hospital, Baltimore, MD (Arman Kilic); and Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH (R.S.D.H., B.A.W., Ahmet Kilic).
authors: Bryan A
authors: BA
authors: Whitson
authors: From Department of Surgery, Johns Hopkins Hospital, Baltimore, MD (Arman Kilic); and Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH (R.S.D.H., B.A.W., Ahmet Kilic). Ahmet.Kilic@osumc.edu.
authors: Ahmet
authors: A
authors: Kilic
mesh_terms: D000328:Adult; D044383:Black People; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D044465:White People
keywords: heart failure; morbidity; mortality; surgery; transplantation