Access to Liver Transplantation in the MELD Era: Role of Ethnicity and Insurance

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http://www.springerlink.com/content/v7x686382063563l/

Journal

Digestive Diseases and Sciences

Publisher

Springer Netherlands

ISSN

0163-2116 (Print) 1573-2568 (Online)

Category

Original Article

DOI

10.1007/s10-5

Subject Collection

Medicine

SpringerLink Date

Wednesday, December 03, 2008

Original Article

Access to Liver Transplantation in the MELD Era: Role of Ethnicity and Insurance

Nyingi Kemmer1, 2 , Zacharias1, E. Kaiser1 and Guy W. Neff1

(1)

University of Cincinnati, 231 Albert Sabin Way, MSB Room 6363, Cincinnati, OH 45267-0595, USA

(2)

Cincinnati VA Medical Center, Cincinnati, USA

Received: 19 May 2008 Accepted: 26 September 2008 Published online: 3 December 2008

Abstract

Factors contributing to inequitable access to liver transplantation include socioeconomic status, geographic location, and delayed referral.

The aim of this study is to identify the factors associated with a high MELD at the time of listing. Using the UNOS database, we identified all adults listed from 2002 to 2006. Data collected included demographics, insurance payor (private and government, i.e., Medicaid and non-Medicaid), diagnosis, and MELD score categorized as low (<20) and high (≥20).

The results obtained show that a high MELD was associated with age, ethnicity, and insurance (P < 0.001). By multivariate analysis, insurance (OR = 1.21, 95% CI = 1.13–1.30, P < 0.001) and ethnicity (OR = 1.55, 95% CI = 1.28–1.88, P < 0.001) were independently associated with high MELD.

In conclusion, ethnic minorities and liver transplant candidates with Medicaid are more likely to have a high MELD score at initial listing. The above results suggest that the type of insurance and ethnicity are independently associated with a high MELD (i.e., sicker patients).

Keywords Liver transplantation - Ethnicity - Insurance