Health Insurance Trajectories and Long-Term Survival After Heart Transplantation. (September 2016)

• Record Type: Journal Article
• Authors: Tumin, Dmitry; Foraker, Randi E.; Smith, Sakima; Tobias, Joseph D.; Hayes, Don
• Is Part Of: Circulation. Volume 9:Number 5(2016)
• Publication Date: 2016-09
• Subjects: heart transplantation -- human -- insurance -- survival -- transplantation; Cardiovascular system -- Diseases -- Treatment -- Periodicals; Cardiovascular system -- Diseases -- Research -- Periodicals; Outcome assessment (Medical care) -- Periodicals; Evidence-based medicine -- Periodicals; 616.1007
• DOI: 10.1161/CIRCOUTCOMES.116.003067
• Languages: English
• ISSNs: 1941-7713

Abstract

Abstract : Background—: Health insurance status at heart transplantation influences recipient survival, but implications of change in insurance for long-term outcomes are unclear. Methods and Results—: Adults aged 18 to 64 receiving first-time orthotopic heart transplants between July 2006 and December 2013 were identified in the United Network for Organ Sharing registry. Patients surviving >1 year were categorized according to trajectory of insurance status (private compared with public) at wait listing, transplantation, and 1-year follow-up. The most common insurance trajectories were continuous private coverage (44%), continuous public coverage (27%), and transition from private to public coverage (11%). Among patients who survived to 1 year (n=9088), continuous public insurance (hazard ratio =1.36; 95% confidence interval 1.19, 1.56; P <0.001) and transition from private to public insurance (hazard ratio =1.25; 95% confidence interval 1.04, 1.50; P =0.017) were associated with increased mortality hazard relative to continuous private insurance. Supplementary analyses of 11 247 patients included all durations of post-transplant survival and examined post-transplant private-to-public and public-to-private transitions as time-varying covariates. In these analyses, transition from private to public insurance was associated with increased mortality hazard (hazard ratio =1.25; 95% confidence interval 1.07, 1.47; P =0.005), whereas transition from public to private insurance was associated with lower mortality hazard (hazard ratio =0.78; 95% confidence interval 0.62, 0.97; P =0.024). Conclusions—: Transition from private to public insurance after heart transplantation is associated with worse long-term outcomes, compounding disparities in post-transplant survival attributed to insurance status at transplantation. By contrast, post-transplant gain of private insurance among patients receiving publicly funded heart transplants was associated with improved outcomes. Abstract : Supplemental Digital Content is available in the text.