Clifford Akateh1,2,3, Dmitry Tumin4,5, Eliza W Beal6,7, Khalid Mumtaz8, Joseph D Tobias4,9, Don Hayes10,11,5, Sylvester M Black7. 1. Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. clifford.akateh@osumc.edu. 2. Division of Transplantation, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. clifford.akateh@osumc.edu. 3. Ohio State University Wexner Medical Center - Faculty Tower, 395 W 12th Ave, Room 654, Columbus, OH, 43210-1267, USA. clifford.akateh@osumc.edu. 4. Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA. 5. Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, 43210, USA. 6. Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. 7. Division of Transplantation, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. 8. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. 9. Department of Anesthesiology and Pain Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43205, USA. 10. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. 11. Section of Pulmonary Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
Abstract
BACKGROUND: Health insurance coverage changes for many patients after liver transplantation, but the implications of this change on long-term outcomes are unclear. AIMS: To assess post-transplant patient and graft survival according to change in insurance coverage within 1 year of transplantation. METHODS: We queried the United Network for Organ Sharing for patients between ages 18-64 years undergoing liver transplantation in 2002-2016. Patients surviving > 1 year were categorized by insurance coverage at transplantation and the 1-year transplant anniversary. Multivariable Cox regression characterized the association between coverage pattern and long-term patient or graft survival. RESULTS: Among 34,487 patients in the analysis, insurance coverage patterns included continuous private coverage (58%), continuous public coverage (29%), private to public transition (8%) and public to private transition (4%). In multivariable analysis of patient survival, continuous public insurance (HR 1.29, CI 1.22, 1.37, p < 0.001), private to public transition (HR 1.17, CI 1.07, 1.28, p < 0.001), and public to private transition (HR 1.14, CI 1.00, 1.29, p = 0.044), were associated with greater mortality hazard, compared to continuous private coverage. After disaggregating public coverage by source, mortality hazard was highest for patients transitioning from private insurance to Medicaid (HR vs. continuous private coverage = 1.32; 95% CI 1.14, 1.52; p < 0.001). Similar differences by insurance category were found for death-censored graft failure. CONCLUSION: Post-transplant transition to public insurance coverage is associated with higher risk of adverse outcomes when compared to retaining private coverage.
BACKGROUND: Health insurance coverage changes for many patients after liver transplantation, but the implications of this change on long-term outcomes are unclear. AIMS: To assess post-transplant patient and graft survival according to change in insurance coverage within 1 year of transplantation. METHODS: We queried the United Network for Organ Sharing for patients between ages 18-64 years undergoing liver transplantation in 2002-2016. Patients surviving > 1 year were categorized by insurance coverage at transplantation and the 1-year transplant anniversary. Multivariable Cox regression characterized the association between coverage pattern and long-term patient or graft survival. RESULTS: Among 34,487 patients in the analysis, insurance coverage patterns included continuous private coverage (58%), continuous public coverage (29%), private to public transition (8%) and public to private transition (4%). In multivariable analysis of patient survival, continuous public insurance (HR 1.29, CI 1.22, 1.37, p < 0.001), private to public transition (HR 1.17, CI 1.07, 1.28, p < 0.001), and public to private transition (HR 1.14, CI 1.00, 1.29, p = 0.044), were associated with greater mortality hazard, compared to continuous private coverage. After disaggregating public coverage by source, mortality hazard was highest for patients transitioning from private insurance to Medicaid (HR vs. continuous private coverage = 1.32; 95% CI 1.14, 1.52; p < 0.001). Similar differences by insurance category were found for death-censored graft failure. CONCLUSION: Post-transplant transition to public insurance coverage is associated with higher risk of adverse outcomes when compared to retaining private coverage.
Authors: Jeremiah G Allen; Eric S Weiss; George J Arnaoutakis; Stuart D Russell; William A Baumgartner; Ashish S Shah; John V Conte Journal: J Heart Lung Transplant Date: 2011-10-01 Impact factor: 10.247
Authors: L N Glueckert; D Redden; M A Thompson; A Haque; S H Gray; J Locke; D E Eckhoff; M Fouad; D A DuBay Journal: Am J Transplant Date: 2013-05-09 Impact factor: 8.086
Authors: C L Bryce; D C Angus; R M Arnold; C-C H Chang; M H Farrell; C Manzarbeitia; I R Marino; M S Roberts Journal: Am J Transplant Date: 2009-07-23 Impact factor: 8.086
Authors: Clifford Akateh; Rebecca Miller; Eliza W Beal; Dmitry Tumin; Joseph D Tobias; Don Hayes; Sylvester M Black Journal: Dig Dis Sci Date: 2019-07-22 Impact factor: 3.199
Authors: Khalid Mumtaz; Jannel Lee-Allen; Kyle Porter; Sean Kelly; James Hanje; Lanla F Conteh; Anthony J Michaels; Ashraf El-Hinnawi; Ken Washburn; Sylvester M Black; Marwan S Abougergi Journal: Sci Rep Date: 2020-11-06 Impact factor: 4.379