Racial differences in waiting list outcomes in chronic obstructive pulmonary disease

Am J Respir Crit Care Med. 2008 Feb 15;177(4):450-4. doi: 10.1164/rccm.200708-1260OC. Epub 2007 Nov 15.

Abstract

Rationale: Blacks with chronic illness have poorer outcomes than whites in the United States. The health outcomes of minorities with chronic obstructive pulmonary disease (COPD) on the lung transplant waiting list have not been studied.

Objectives: To compare outcomes of black and white patients with COPD after listing for lung transplantation in the United States.

Methods: Retrospective cohort study of all 280 non-Hispanic black and 5,272 non-Hispanic white adults 40 years and older with COPD listed for lung transplantation in the United States between 1995 and 2004.

Measurements and main results: Blacks with COPD were more likely to have pulmonary hypertension, obesity, and diabetes; to lack private health insurance; and to live in poorer neighborhoods than whites. Blacks were less likely to undergo transplantation after listing compared with whites, despite adjustment for age, lung function, pulmonary hypertension, cardiovascular risk factors, insurance coverage, and poverty level (adjusted hazard ratio, 0.83; 95% confidence interval, 0.70-0.98; P = 0.03). This was accompanied by a greater risk of dying or being removed from the list among blacks (unadjusted hazard ratio, 1.31; 95% confidence interval, 1.05-1.63; P = 0.02).

Conclusions: After listing for lung transplantation, black patients with COPD were less likely to undergo transplantation and more likely to die or be removed from the list compared with white patients. Unequal access to care may have contributed to these differences.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • African Americans / statistics & numerical data*
  • Aged
  • Cohort Studies
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Lung Transplantation / ethnology*
  • Lung Transplantation / statistics & numerical data
  • Male
  • Markov Chains
  • Middle Aged
  • Outcome Assessment, Health Care
  • Proportional Hazards Models
  • Pulmonary Disease, Chronic Obstructive / ethnology*
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Pulmonary Disease, Chronic Obstructive / surgery*
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Survival Analysis
  • United States / epidemiology
  • Waiting Lists*