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Lack of private insurance contribute to higher deaths among black heart transplant patients
Date:5/31/2010

ding fever, shortness of breath, fatigue, and swelling in the arms and legs.

Among the researchers' other key findings were that such problems related to organ rejection within the first year, regardless of race, were tied to insurance and education. Patients with public insurance, specifically Medicaid, had a 30 percent higher risk of needing some kind of antirejection treatment and a 39 percent higher risk of dying than transplant recipients with private insurance. Transplant recipients on Medicare did not fare well either, with a 12 percent higher risk of dying than those with private insurance. Having a college education lowered the overall group's likelihood of having a rejection-related problem with their transplant by 12 percent.

In the study population, 20.5 percent of black transplant recipients had Medicaid insurance compared to 8.8 percent of other races, and fewer had private insurance (49.9 percent) compared to others (63.6 percent). The African-American group as a whole had a lower percentage of college graduates than other races (at 40.6 percent and 50.3 percent).

Black recipients also had a higher degree of tissue antigen mismatches with their transplanted hearts compared to other groups (at 65.4 percent and 55.6 percent.) The better the match, Shah says, the better the chances that immunosuppressive drugs will work over the long term to prevent organ rejection. Hypertension and gender mismatches, factors known to up the chances of dying, were also more widespread among African Americans.

Lead study investigator Jeremiah (Geoff) Allen, M.D., says a combination of these circumstances in African Americans likely contribute to their poorer outcomes.

Allen, a postdoctoral research fellow in cardiac surgery at Johns Hopkins, says the team's next steps are to identify which combination of factors stands out among those blacks who survive long term post-transplant and those who do not. Some 45 perce
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Contact: David March
dmarch1@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
Source:Eurekalert

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