Increased Mortality in Adult Cystic Fibrosis Patients with Medicaid Insurance Awaiting Lung Transplantation

Purpose Cystic fibrosis (CF) is a progressive disease resulting in end-stage lung disease. Lung transplantation (LTx) is an important consideration in these patients. Studies have suggested greater post-LTx mortality among CF patients with public insurance. We evaluated the influence of insurance st...

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Bibliographic Details
Published in:Lung 2016-10, Vol.194 (5), p.799-806
Main Authors: Krivchenia, Katelyn, Tumin, Dmitry, Tobias, Joseph D., Hayes, Don
Format: Article
Language:English
Subjects:
Adult
Care and treatment
Complications and side effects
Confounding Factors (Epidemiology)
Cystic fibrosis
Cystic Fibrosis - mortality
Cystic Fibrosis - surgery
Educational Status
Female
Humans
Insurance, Health - statistics & numerical data
Kaplan-Meier Estimate
Lung diseases
Lung Transplantation
Male
Medicaid
Medicaid - statistics & numerical data
Medicare - statistics & numerical data
Medicine
Medicine & Public Health
Mortality
Pneumology/Respiratory System
Proportional Hazards Models
Severity of Illness Index
Survival Rate
Transplants & implants
United States
United States - epidemiology
Waiting Lists - mortality
Young Adult
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Summary:Purpose Cystic fibrosis (CF) is a progressive disease resulting in end-stage lung disease. Lung transplantation (LTx) is an important consideration in these patients. Studies have suggested greater post-LTx mortality among CF patients with public insurance. We evaluated the influence of insurance status on survival among CF patients during their time on the LTx waitlist. Methods Adult LTx candidates diagnosed with CF and listed since the implementation of the lung allocation score, from May 2005 until September 2013, were identified in the United Network for Organ Sharing database. Waitlist mortality was compared across projected primary payment type (private insurance or self-pay; Medicaid; Medicare) using Kaplan–Meier functions and Fine–Gray competing-risks survival analysis, accounting for the competing risk of transplantation. Results 1770 LTx candidates with CF were included in univariate survival analyses, with Medicaid increasing waitlist mortality hazard relative to private insurance (HR 2.28; 95 % CI 1.62, 3.21; p  
ISSN:0341-2040
1432-1750
DOI:10.1007/s00408-016-9927-7