Dmitry Tumin1, Randi E Foraker2, Sakima Smith2, Joseph D Tobias2, Don Hayes2. 1. From the Departments of Pediatrics (D.T., D.H.), Anesthesiology (J.D.T.), Internal Medicine (R.E.F., S.S., D.H.), and Surgery (D.H.), The Ohio State University College of Medicine, Columbus; Division of Epidemiology, The Ohio State University College of Public Health, Columbus (R.E.F.); Center for the Epidemiological Study of Organ Failure and Transplantation (D.T., R.E.F., S.S., J.D.T., D.H.), Department of Anesthesiology and Pain Medicine (D.T., J.D.T.), Section of Pulmonary Medicine (D.H.), Nationwide Children's Hospital, Columbus, OH. tumin.1@osu.edu. 2. From the Departments of Pediatrics (D.T., D.H.), Anesthesiology (J.D.T.), Internal Medicine (R.E.F., S.S., D.H.), and Surgery (D.H.), The Ohio State University College of Medicine, Columbus; Division of Epidemiology, The Ohio State University College of Public Health, Columbus (R.E.F.); Center for the Epidemiological Study of Organ Failure and Transplantation (D.T., R.E.F., S.S., J.D.T., D.H.), Department of Anesthesiology and Pain Medicine (D.T., J.D.T.), Section of Pulmonary Medicine (D.H.), Nationwide Children's Hospital, Columbus, OH.
Abstract
BACKGROUND: Health insurance status at heart transplantation influences recipient survival, but implications of change in insurance for long-term outcomes are unclear. METHODS AND RESULTS: Adults aged 18 to 64 receiving first-time orthotopic heart transplants between July 2006 and December 2013 were identified in the United Network for Organ Sharing registry. Patients surviving >1 year were categorized according to trajectory of insurance status (private compared with public) at wait listing, transplantation, and 1-year follow-up. The most common insurance trajectories were continuous private coverage (44%), continuous public coverage (27%), and transition from private to public coverage (11%). Among patients who survived to 1 year (n=9088), continuous public insurance (hazard ratio =1.36; 95% confidence interval 1.19, 1.56; P<0.001) and transition from private to public insurance (hazard ratio =1.25; 95% confidence interval 1.04, 1.50; P=0.017) were associated with increased mortality hazard relative to continuous private insurance. Supplementary analyses of 11 247 patients included all durations of post-transplant survival and examined post-transplant private-to-public and public-to-private transitions as time-varying covariates. In these analyses, transition from private to public insurance was associated with increased mortality hazard (hazard ratio =1.25; 95% confidence interval 1.07, 1.47; P=0.005), whereas transition from public to private insurance was associated with lower mortality hazard (hazard ratio =0.78; 95% confidence interval 0.62, 0.97; P=0.024). CONCLUSIONS: Transition from private to public insurance after heart transplantation is associated with worse long-term outcomes, compounding disparities in post-transplant survival attributed to insurance status at transplantation. By contrast, post-transplant gain of private insurance among patients receiving publicly funded heart transplants was associated with improved outcomes.
BACKGROUND: Health insurance status at heart transplantation influences recipient survival, but implications of change in insurance for long-term outcomes are unclear. METHODS AND RESULTS: Adults aged 18 to 64 receiving first-time orthotopic heart transplants between July 2006 and December 2013 were identified in the United Network for Organ Sharing registry. Patients surviving >1 year were categorized according to trajectory of insurance status (private compared with public) at wait listing, transplantation, and 1-year follow-up. The most common insurance trajectories were continuous private coverage (44%), continuous public coverage (27%), and transition from private to public coverage (11%). Among patients who survived to 1 year (n=9088), continuous public insurance (hazard ratio =1.36; 95% confidence interval 1.19, 1.56; P<0.001) and transition from private to public insurance (hazard ratio =1.25; 95% confidence interval 1.04, 1.50; P=0.017) were associated with increased mortality hazard relative to continuous private insurance. Supplementary analyses of 11 247 patients included all durations of post-transplant survival and examined post-transplant private-to-public and public-to-private transitions as time-varying covariates. In these analyses, transition from private to public insurance was associated with increased mortality hazard (hazard ratio =1.25; 95% confidence interval 1.07, 1.47; P=0.005), whereas transition from public to private insurance was associated with lower mortality hazard (hazard ratio =0.78; 95% confidence interval 0.62, 0.97; P=0.024). CONCLUSIONS: Transition from private to public insurance after heart transplantation is associated with worse long-term outcomes, compounding disparities in post-transplant survival attributed to insurance status at transplantation. By contrast, post-transplant gain of private insurance among patients receiving publicly funded heart transplants was associated with improved outcomes.
Authors: Clifford Akateh; Dmitry Tumin; Eliza W Beal; Khalid Mumtaz; Joseph D Tobias; Don Hayes; Sylvester M Black Journal: Dig Dis Sci Date: 2018-03-24 Impact factor: 3.199
Authors: Sarah Streeter Hutcheson; Victoria Phillips; Rachel Patzer; Andrew Smith; J David Vega; Alanna A Morris Journal: Clin Transplant Date: 2018-07-11 Impact factor: 2.863
Authors: Dmitry Tumin; Jessica Horan; Emily A Shrider; Sakima A Smith; Joseph D Tobias; Don Hayes; Randi E Foraker Journal: Am Heart J Date: 2017-06-03 Impact factor: 4.749
Authors: Jaimin R Trivedi; Siddharth V Pahwa; Katherine R Whitehouse; Bradley M Ceremuga; Mark S Slaughter Journal: PLoS One Date: 2022-01-26 Impact factor: 3.240