Sociodemographic differences in early access to liver transplantation services

Area of Science:

• Hepatology
• Transplantation Medicine
• Health Services Research

Background:

• Healthcare inequities in end-stage liver disease (ESLD) patient access to transplantation are not well-understood.
• Previous research has not adequately assessed disparities prior to transplant waitlisting.

Purpose of the Study:

• To determine the impact of gender, race, and insurance status on access to liver transplantation.
• To investigate whether health care inequities occur before patients with ESLD are waitlisted.

Main Methods:

• Linked Pennsylvania patient discharge data (1994-2001) with transplant center records through 2003.
• Utilized multinomial logistic regressions to estimate probabilities of transplant evaluation, waitlisting, and transplantation.
• Analyzed data from 144,507 adult patients discharged from non-governmental hospitals.

Main Results:

• Only 3.0% of patients underwent transplant evaluation, 70.4% of those evaluated were waitlisted, and 50.0% of those waitlisted received a transplant.
• Women, Black patients, and those lacking commercial insurance were significantly less likely to undergo evaluation, waitlisting, and transplantation (p < 0.001).
• Disparities were more pronounced in the early stages (evaluation and listing) compared to the transplantation stage.

Conclusions:

• Significant health care inequities exist in the pre-waitlisting stages for patients with ESLD.
• Gender, race, and insurance status are critical factors influencing access to liver transplant evaluation and listing.
• More comprehensive data on referral and listing practices are needed to understand and address early management disparities in ESLD care.