Wayne M Tsuang1, Susana Arrigain2,3, Rocio Lopez2,3, Megan Snair2,3, Marie Budev1, Jesse D Schold2,3. 1. Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH. 2. Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH. 3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
Abstract
BACKGROUND: In response to a longstanding Federal mandate to minimize the role of geography in access to transplant in the United States, we assessed whether patient travel distance was associated with lung transplant outcomes. We focused on the posttransplant time period, when the majority of patient visits to a transplant center occur. METHODS: We present a cohort study of lung transplants in the United States between January 1, 2006, and May 31, 2017. Travel distance was measured from the patient's permanent home zip code to the transplant center using SAS URL access to GoogleMaps. We leveraged data from the US Census, US Department of Agriculture, and the Economic Innovations Group to assess socioeconomic status. Multivariable Cox models were used to assess graft survival. RESULTS: We included 18 128 patients who met the inclusion criteria. Median distance was 69.6 miles. Among patients who traveled >60 miles to reach a transplant center, 41.8% bypassed a closer center and sought care at a more distant center. Patients traveling longer distances sought care at centers with a higher annual transplant volume. In the adjusted Cox Model, patients who traveled >360 miles had a slightly higher risk for posttransplant graft failure than patients traveling ≤60 miles (hazard ratio 1.09; 95% CI, 1.01-1.18), and a higher risk for treated acute rejection (hazard ratio, 1.63; 95% CI, 1.43-1.86). CONCLUSIONS: Travel distance was significantly associated with post lung transplant survival. However, this effect was relatively modest. Patient travel distance is an important component of access to lung transplant care.
BACKGROUND: In response to a longstanding Federal mandate to minimize the role of geography in access to transplant in the United States, we assessed whether patient travel distance was associated with lung transplant outcomes. We focused on the posttransplant time period, when the majority of patient visits to a transplant center occur. METHODS: We present a cohort study of lung transplants in the United States between January 1, 2006, and May 31, 2017. Travel distance was measured from the patient's permanent home zip code to the transplant center using SAS URL access to GoogleMaps. We leveraged data from the US Census, US Department of Agriculture, and the Economic Innovations Group to assess socioeconomic status. Multivariable Cox models were used to assess graft survival. RESULTS: We included 18 128 patients who met the inclusion criteria. Median distance was 69.6 miles. Among patients who traveled >60 miles to reach a transplant center, 41.8% bypassed a closer center and sought care at a more distant center. Patients traveling longer distances sought care at centers with a higher annual transplant volume. In the adjusted Cox Model, patients who traveled >360 miles had a slightly higher risk for posttransplant graft failure than patients traveling ≤60 miles (hazard ratio 1.09; 95% CI, 1.01-1.18), and a higher risk for treated acute rejection (hazard ratio, 1.63; 95% CI, 1.43-1.86). CONCLUSIONS: Travel distance was significantly associated with post lung transplant survival. However, this effect was relatively modest. Patient travel distance is an important component of access to lung transplant care.
Authors: M Valapour; C J Lehr; M A Skeans; J M Smith; K Uccellini; R Lehman; A Robinson; A K Israni; J J Snyder; B L Kasiske Journal: Am J Transplant Date: 2019-02 Impact factor: 8.086
Authors: Arman Kilic; Thomas G Gleason; Hiroshi Kagawa; Ahmet Kilic; Ibrahim Sultan Journal: Eur J Cardiothorac Surg Date: 2019-02-02 Impact factor: 4.191
Authors: Allison J Kwong; Ajitha Mannalithara; Julie Heimbach; Matthew A Prentice; W Ray Kim Journal: Clin Gastroenterol Hepatol Date: 2019-05-08 Impact factor: 11.382
Authors: David A Axelrod; Nino Dzebisashvili; Mark A Schnitzler; Paolo R Salvalaggio; Dorry L Segev; Sommer E Gentry; Janet Tuttle-Newhall; Krista L Lentine Journal: Clin J Am Soc Nephrol Date: 2010-08-26 Impact factor: 8.237
Authors: T M Egan; S Murray; R T Bustami; T H Shearon; K P McCullough; L B Edwards; M A Coke; E R Garrity; S C Sweet; D A Heiney; F L Grover Journal: Am J Transplant Date: 2006 Impact factor: 8.086
Authors: Kristopher P Croome; David D Lee; Justin M Burns; Dana K Perry; Andrew P Keaveny; C Burcin Taner Journal: PLoS One Date: 2015-10-15 Impact factor: 3.240
Authors: Gwilym J Webb; James Hodson; Abhishek Chauhan; John O'Grady; James M Neuberger; Gideon M Hirschfield; James W Ferguson Journal: Am J Transplant Date: 2018-08-03 Impact factor: 8.086