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Published on: June 23, 2014
Impact of Insurance Type on Initial Rejection Post Heart Transplant
Khadijah Breathett1, Shannon Willis2, Randi E Foraker3
1Division of Cardiology, University of Colorado Anschutz Medical Center, Aurora, Colorado.
Insights
Socioeconomic status, including Medicaid insurance and income, does not impact heart transplant rejection risk. Comorbidities like diabetes and younger age (≤60) are key factors in severe cellular rejection post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Services Research
Background:
- Heart transplant allocation is often restricted for patients with low socioeconomic status (SES) due to concerns about poorer outcomes.
- This study investigated whether comorbidities pose a greater risk for severe rejection post-orthotopic heart transplant than SES indicators like Medicaid insurance and Median Household Income (MHI).
Purpose of the Study:
- To determine the association between socioeconomic status (SES) indicators (Medicaid insurance, MHI) and the risk of severe cellular rejection after orthotopic heart transplant.
- To compare the impact of SES indicators versus comorbidities on post-transplant rejection risk.
Main Methods:
- A retrospective analysis of 171 patients undergoing orthotopic heart transplant between July 1999 and November 2013.
- Patients were followed until September 2014 to record rejection hospitalizations or death.
- Survival and multivariable analyses were performed, adjusting for age, race, and gender, to estimate the risk of severe cellular rejection (≥2r).
Main Results:
- In univariable analysis, Medicaid and diabetes were linked to increased rejection risk, while older age (>60), Caucasian race, and male sex showed reduced risk.
- Median Household Income (MHI) showed no correlation with rejection risk.
- In the multivariable model, Medicaid was not associated with rejection; however, diabetes remained strongly associated with increased risk, and age >60 years was associated with reduced risk.
Conclusions:
- Medicaid insurance and MHI were not associated with an increased risk of severe cellular rejection requiring hospitalization post-orthotopic heart transplant in the adjusted model.
- The presence of diabetes and younger age (≤60 years) were identified as significant risk factors for severe cellular rejection.
Background:
Heart transplantation allocation is often restricted from patients with low socioeconomic status (SES) due to concern for worse outcomes. We hypothesised that comorbidities would have a greater impact on risk of severe rejection post-orthotopic heart transplant than would Medicaid insurance and Median Household Income (MHI).
Methods:
A retrospective study of 171 patients who underwent orthotopic heart transplant between 7/1999-11/2013 at our facility were followed until 9/2014 for rejection hospitalisations or death. Survival and multivariable analyses with adjustment for age, race, and gender were performed to estimate the risk of severe cellular rejection, ≥2r (hazard ratio [HR], 95% confidence interval [CI]).
Results:
Eighteen per cent of patients had Medicaid, and 72% of patients had low or medium MHI. Severe rejection occurred in 23% of patients. In the univariable analysis, Medicaid and diabetes were associated with increased risk of rejection while age >60 years, Caucasian race, and male sex were associated with reduced risk [Medicaid 2.32(1.20,4.51), diabetes 2.49(1.09,5.69), age 0.41(0.20,0.84), Caucasian 0.44(0.21,0.93), male 0.49(0.26,0.92)]. Median Household Income had no correlation [MHI 0.79(0.51,1.23)]. In the multivariable adjusted model, Medicaid was not associated with rejection [1.65(0.79,3.41)]; diabetes was strongly associated with risk of severe rejection [3.9(1.59,9.39)], and age >60 years was associated with risk reduction [0.42(0.20,0.82)].
Conclusions:
Medicaid insurance and MHI were not associated with increased risk of severe cellular rejection requiring hospitalisation post-orthotopic heart transplant in the adjusted model. Rather the presence of diabetes and age ≤60 years were associated with increased risk.
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