Guest guest Posted December 5, 2008 Report Share Posted December 5, 2008  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 Quote Link to comment Share on other sites More sharing options...
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