After initial evaluations, patients with adult cystic fibrosis (CF) have a greater likelihood of not being accepted for lung transplants.

Lead author Bradley S. Quon, MD, MSc, MBA, of the University of Washington Medical Center in Seattle and his team conducted a new study that established, for the first time, many factors indicating socioeconomic status is linked with greater rates of not being accepted for transplant.

The study, published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine, included 2,167 patients from the CF foundation patient registry who had their first lung transplant evaluation between January 1, 2001 and December 31, 2009.

Medicaid insurance receipts were used to identify socioeconomic status. Patients who were deferred or denied were classified as “not accepted”. A performance based sensitivity analysis was given depending on whether they were accepted or declined at the end of the study.

Out of all patients in the study, 47% received Medicaid. In comparison with non-medicaid patients, rates of not being accepted for lung transplant were 1.56 fold among recipients of Medicaid. This relationship was separate from factors such as severity, lung allocation score, and demographic characteristics.

Residing in lower income zip codes and not graduating from high school were associated with not being accepted for transplant after the first evaluation, which could be elements of socioeconomic status.

Several limitations were seen in this study like using Medicaid and other agents for socioeconomic status. In addition, insufficient social support and poor adherence are key predictors of transplant eligibility. Only partial adjustment for these factors may explain why low socioeconomic status was linked to rejection from lung transplantation.

Dr. Quon concludes:

“The results of our study are concerning, as the effects of SES status on access to lung transplant appear to be unrelated to differences in disease severity or potential contraindications. More research is needed to explore the factors associated with Medicaid status that negatively impact lung transplant access and to assess whether these disparities are seen in other pre-lung transplant patient populations.”

Written by Kelly Fitzgerald