title: Insurance status by region at the time of heart transplantation: Implications for survival.
abstract: Heart transplantation outcomes differ by health insurance status and geographic region of the United States. We hypothesized that heart transplantation survival would be affected by health insurance status within certain United Network for Organ Sharing (UNOS) regions.
  
  
  
  We used data from the UNOS thoracic database to classify health insurance status into private or public (private/self-pay or Medicare/Medicaid) for all first-time heart transplant recipients between July 2006 and September 2013. We applied Cox proportional hazards regression to estimate hazard ratio (HR) and 95% confidence interval (CI) for the influences of health insurance status on 1-year and long-term survival in heart transplant recipients by UNOS region.
  
  
  
  Mean survival time among 10,474 patients was 942 days ± 704. All key demographic and clinical variables varied significantly across UNOS regions. With respect to 1-year survival, patients in Region 2 had a higher hazard of mortality (HR, 1.49; 95% CI, 1.03, 2.15) if they had public vs private insurance. When we restricted the analysis to be conditional on 1-year survival, 2 contiguous regions, Region 10, including Indiana, Ohio, Michigan (HR, 2.30; 95% CI, 1.23, 4.28), and Region 11 (HR, 1.85; 95% CI, 1.15, 2.97), including the upper South, had poor survival associated with public vs private insurance.
  
  
  
  The data we present invite targeted efforts by certain UNOS regions to improve the standard of care and/or eligibility thresholds for heart transplant recipients.
authors.affiliation: Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: rforaker@cph.osu.edu.
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
authors.affiliation: Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
authors.affiliation: Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Sakima
authors.initials: S
authors.lastname: Smith
authors.affiliation: Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
mesh_terms: D016027:Heart Transplantation; D006801:Humans; D019458:Insurance Coverage; D009820:Ohio; D016016:Proportional Hazards Models; D015996:Survival Rate; D014481:United States
keywords: health insurance; heart transplantation; region; survival