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Race Matters For Patients Awaiting Lung Transplants
A recent study published in the American Journal of
Respiratory and Critical Care Medicine finds that compared to
whites, blacks with chronic obstructive pulmonary disease, or COPD,
were less
likely to receive a lung transplant. Blacks were also more likely than
whites to die or be
removed from the transplant list.
Columbia University researcher David Lederer and colleagues analyzed
280 non-Hispanic black adults and 5,272 non-Hispanic white adults who
were diagnosed with COPD or emphysema. All members of the sample were
awaiting lung transplants on the United Network for Organ Sharing
(UNOS) list between 1995 and 2004. The researchers tracked patients to
the end of the study period until they died, received a transplant,
were removed from the list, or were still living and awaiting
transplant. The results were examined with respect to age, sex, disease
severity, community poverty level, and transplant center volume.
After controlling for age, lung function, cardiovascular risk factors,
transplant center volume, type of health insurance, and approximate
poverty level, Lederer and colleagues showed that "black patients with
COPD were less likely to
undergo lung transplantation after listing than white patients in the
United
States during the late 1990's and the early 2000's"
They note that this finding and other "disparities are consistent with
those observed among patients
awaiting kidney and liver transplantation and among patients with other
advanced lung diseases such as pulmonary arterial hypertension and
pulmonary fibrosis."
Blacks were also less likely to have
private insurance and more likely to live in poorer neighborhoods.
Greater cardiovascular risk factors, such as diabetes, pulmonary
hypertension and lower six-minute walk distances were observed in
blacks compared to whites. However, even these factors did not account
for the differences between the two groups regarding lung
transplantation.
"Differences in insurance, socioeconomic status and cardiovascular risk
factors explained some but not all of the higher risk of death or
removal from the waiting list," said Dr. Lederer.
The researchers also found that Hispanics had
similar outcomes to non-Hispanic blacks. During the ten-year study
period, only 280 black and 64 Hispanic patients with COPD were put
on the lung transplant waiting list in the United States. Lederer adds
that "based on what we know about COPD, we expected that twice as many
black patients would have been put on the
ling transplant waiting list. Our findings point to significant
barriers to accessing lung transplantation for minorities."
The authors maintain that their findings "should alert primary care
physicians and pulmonologists to
consider referral of black patients with COPD for transplantation at
the earliest signs of advanced disease." In addition, patients can
protect themselves from these racial differences by preparing
themselves for transplantation "by discussing all of
their treatment options with their doctor. To be eligible for lung
transplantation, patients must quit smoking, use medications and oxygen
as prescribed, and participate in a pulmonary rehabilitation program to
increase their strength and endurance."
Since the study period, the organ allocation system has been replaced
with one that prioritizes patients based on the survival benefit of the
transplant. However, blacks will still be more likely to be removed
from the transplant list or to die due to poor
insurance and poverty compared to whites, warns Lederer.
The authors conclude by calling for research that identifies "the
specific barriers that patients
encounter while trying to get on the waiting list for a lung
transplant. Once we figure out the root of the problem, we can begin to
improve access for all patients with COPD."
Racial Differences in Waiting List Outcomes in Chronic
Obstructive Pulmonary Disease
David J. Lederer, Emma K. T. Benn, R. Graham Barr, Jessie S. Wilt,
Genevieve Reilly, Joshua R. Sonett, Selim M. Arcasoy, and Steven M.
Kawut
American Journal of Respiratory and Critical Care Medicine. Volume
177, Issue 4.
pp. 450-454, (2008)
doi:10.1164/rccm.200708-1260OC
Click
Here to View Abstract
Written by: Peter M Crosta
Copyright: Start Sanatate
Not to be reproduced without permission of Start Sanatate
Cursa de Table materie de pacienþi care aºteaptã transplant pulmonar - Race Matters For Patients Awaiting Lung Transplants - articole medicale engleza - startsanatate