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Blacks Awaiting Lung Transplants Face Poorer Outcomes

Findings point to significant barriers to accessing timely care for minorities

FRIDAY, Feb. 15 (HealthDay News) -- Blacks awaiting a lung transplant during a recent 10-year period were less likely to receive a new lung and more likely to die or be removed from the transplant list than whites, according to researchers.

The findings, published in the second February issue of the American Journal of Respiratory and Critical Care Medicine, also showed that blacks on the transplant list between 1995 and 2004 were more likely to lack private insurance, live in poorer neighborhoods, and have greater cardiovascular risk factors, such as diabetes and pulmonary hypertension. However, these factors did not account for the findings.

These disparities are consistent with those observed among patients awaiting kidney and liver transplantation and among patients with other advanced lung diseases such as pulmonary arterial hypertension and pulmonary fibrosis, lead researcher Dr. David Lederer, of Columbia University Medical Center, said in a prepared statement. This finding was independent of age, lung function, cardiovascular risk factors, transplant center volume, type of health insurance coverage, and neighborhood poverty level.

The researchers assessed the 280 non-Hispanic black adults and 5,272 non-Hispanic white adults diagnosed with chronic obstructive pulmonary disease (COPD) or emphysema who were on the United Network for Organ Sharing lung transplantation list between 1995 and 2004. The investigators tracked the outcomes (death, transplantation, removal from the list or still living) of those on the list and analyzed the results with respect to age, sex, disease severity, community poverty level and transplant center volume.

While the organ allocation system in place during the study period has been replaced with one that prioritizes patients based on the survival benefit of transplantation, Lederer said the effects of poor insurance and poverty will likely still place blacks at increased risk for removal from the list or death.

Also, researchers were surprised at the low number of blacks that even made the list. "Based on what we know about COPD, we expected that twice as many black patients would have been put on the lung transplant waiting list. Our findings point to significant barriers to accessing lung transplantation for minorities," Lederer said. "These findings should alert primary-care physicians and pulmonologists to consider referral of black patients with COPD for transplantation at the earliest signs of advanced disease."

More information

The National Heart, Lung, and Blood has more about chronic obstructive pulmonary disease.

-- Kevin McKeever

SOURCE: American Thoracic Society, news release, Feb. 15, 2008

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