Socioeconomic Differences in Navigating Access to Lung Transplant.

Area of Science:

• Pulmonary Medicine
• Transplant Surgery
• Health Services Research

Background:

• Inequitable access to organ transplantation in the US is a recognized issue.
• Upstream disparities in pre-transplant care remain poorly understood.
• Understanding these disparities is vital for improving equitable access to lung transplantation.

Purpose of the Study:

• To investigate patterns of referral for lung transplantation based on race, ethnicity, and neighborhood socioeconomic status.
• To identify disparities in the lung transplant care continuum.

Main Methods:

• Retrospective cohort study of adults (18-80 years) with obstructive and restrictive lung disease.
• Data collected from a large-volume transplant center (2006-2023).
• Cause-specific Cox proportional hazards regression models used to analyze outcomes, accounting for death as a competing risk.

Main Results:

• Patients in least-resourced neighborhoods had significantly higher mortality risks at all stages of the transplant care continuum.
• Socioeconomically disadvantaged patients were less likely to transition to pulmonary medicine or be placed on the waiting list.
• Non-Hispanic Black patients showed a lower likelihood of proceeding to lung transplant evaluation, despite lower overall mortality risks.

Conclusions:

• Socioeconomic disadvantage and minority status are associated with increased mortality and decreased likelihood of care escalation in the lung transplant pathway.
• These findings highlight the need for interventions to promote equitable access to lung transplantation.
• Addressing upstream disparities is essential for achieving fairness in organ transplantation.