Urban and Rural Disparities in Access to Heart and Lung Transplantation

To evaluate disparities in access to heart and lung transplantation across both urban and rural areas in the United States (US).

We queried the United Network for Organ Sharing database for centers performing heart and lung transplantation. We calculated travel times between these transplant centers and all 84,000 census tracts using ArcGIS. Demographic information was obtained from the Census Bureau. Distressed community index scores based on metrics including education and poverty were collected. Univariable and multivariable regression was performed to assess characteristics associated with increased travel times.

We identified 130 active transplant centers in the United States. A greater proportion of the rural versus urban population lives more than 60 min (57% versus 28%; P < 0.001) and 240 min (6.5% versus 1.7%; P < 0.001) from a transplant center. Travel times increased with higher community distress as measured by increased distressed community index scores (P < 0.001). In both urban and rural areas, travel times in the most distressed communities were four times those of the least distressed communities. Individuals needing to travel more than 240 min to a transplant center were more likely to be from rural census tracts, live in the Southern, Midwestern, or Western United States, live in areas with a higher proportion of White residents, and areas with higher uninsured rates.

For both urban and rural communities, increased community distress is associated with worse access to heart/lung transplantation. This is compounded for rural residents, highlighting the need to address geographical disparities.