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

• Published in: Digestive diseases and sciences 2009-08, Vol.54 (8), p.1794-1797
• Main Authors: Kemmer, Nyingi, Zacharias, Victoria, Kaiser, Tiffany E, Neff, Guy W
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Biochemistry; Biological and medical sciences; Continental Population Groups; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology; Geography; Health Services Accessibility - trends; Hepatology; Humans; Insurance, Health - economics; Liver Diseases - classification; Liver Diseases - economics; Liver Diseases - ethnology; Liver Diseases - surgery; Liver Transplantation - economics; Liver Transplantation - ethnology; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medicaid - economics; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Models, Statistical; Multivariate Analysis; Oncology; Original Article; Referral and Consultation; Retrospective Studies; Severity of Illness Index; Socioeconomic Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Transplant Surgery; United States; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Young Adult
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-008-0567-5

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). 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).