Patient Travel Distance and Post Lung Transplant Survival in the United States: A Cohort Study.

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.

journal_name

Transplantation

journal_title

Transplantation

authors

Tsuang WM,Arrigain S,Lopez R,Snair M,Budev M,Schold JD

doi

10.1097/TP.0000000000003129

subject

Has Abstract

pub_date

2020-11-01 00:00:00

pages

2365-2372

issue

11

eissn

0041-1337

issn

1534-6080

pii

00007890-202011000-00027

journal_volume

104

pub_type

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