Original Clinical Science
The intersection of race and ethnicity, gender, and primary diagnosis on lung transplantation outcomes

https://doi.org/10.1016/j.healun.2023.02.1496Get rights and content

Background

Reducing racial disparities in lung transplant outcomes is a current priority of providers, policymakers, and lung transplant centers. It is unknown how the combined effect of race and ethnicity, gender, and diagnosis group is associated with differences in 1-year mortality and 5-year survival.

Methods

This is a longitudinal cohort study using Standard Transplant Analysis Research files from the United Network for organ sharing. A total of 25,444 patients undergoing first time lung transplantation between 2006 and 2019 in the United States. The primary exposures were lung transplant recipient race and ethnicity, gender, and primary diagnosis group at listing. Multivariable regression models and cox-proportional hazards models were used to determine adjusted 1-year mortality and 5-year survival.

Results

Overall, 25,444 lung transplant patients were included in the cohort including 15,160 (59.6%) men, 21,345 (83.9%) White, 2,318 (9.1%), Black and Hispanic/Latino (7.0%). Overall, men had a significant higher 1-year mortality than women (11.87%; 95% CI 11.07-12.67 vs 12.82%; 95% CI 12.20%-13.44%). Black women had the highest mortality of all race and gender combinations (14.51%; 95% CI 12.15%-16.87%). Black patients with pulmonary vascular disease had the highest 1-year mortality (19.77%; 95% CI 12.46%-27.08%) while Hispanic/Latino patients with obstructive lung disease had the lowest (7.42%; 95% CI 2.8%-12.05%). 5-year adjusted survival was highest among Hispanic/Latino patients (62.32%) compared to Black (57.59%) and White patients (57.82%).

Conclusions

There are significant differences in 1-year and 5-year mortality between and within racial and ethnic groups depending on gender and primary diagnosis. This demonstrates the impact of social and clinical factors on lung transplant outcomes.

Section snippets

Data source and study population

We used the Organ Procurement and Transplant Network (OPTN) Standard Transplant Analysis and Research (STAR) file to identify patients who underwent lung transplantation from 2006 to 2019. The STAR file is a nationwide registry that collects transplant clinical characteristics and outcomes for all patients undergoing transplantation. Patients older than 18 years old undergoing either first time unilateral or bilateral lung transplantation were included. Patients undergoing multi-organ

Results

A total of 25,444 patients were included in the cohort including 15,160 (59.6%) men with a mean (SD) age of 56.0 (13.1) years old. The racial and ethnic composition of patients undergoing lung transplantation in the study period was 21,345 (83.9%) White, 2,318 (9.1%) Black, and 1,781 (7.0%) Hispanic/Latino. Patient characteristics for each racial and ethnic group are shown in Table 1. White patients had a significantly higher mean (SD) age (56.5[13.2]) compared to Black (53.4[11.0]) and

Discussion

Our findings improve our understanding of lung transplantation disparities by assessing the intersection of race, gender, and diagnosis group. First, evaluation of the combined effect of race and gender on 1-year mortality found that Black women had the highest overall 1-year mortality followed by white men, despite men broadly having an overall higher mortality rate compared to women. Second, we found that for all racial groups’ women had higher 5-year survival compared to men. Third, we found

Limitations

Our results should be considered in light of several limitations. First, the Organ Procurement and Transplant Network Standard Transplant Analysis and Research data used for this analysis is collected and reported by each transplant center. It is possible that errors in data collection or entry may exist at transplant centers leading to some missing values for lung transplant recipients. However, this data is heavily audited for reporting and is the most reliable source of transplant data that

Conclusions

In summary, we found that significant variation in mortality and survival occurred between White, Black, and Hispanic patients and within each individual racial and ethnic group depending on gender as well as primary diagnosis. Contrary to prior literature, we found that Black women the worst 1-year mortality rates after lung transplantation. Future analysis of transplantation outcomes should continue to evaluate how the combination of both social and clinical factors impact the continuum of

Disclosure statement

The authors have no disclosures to report.

Financial support

Sidra Bonner receives funding from the NIH T32 Multidisciplinary Program in Lung Disease at the University of Michigan (NHLBI T32HL007749). Valeria Valbuena is supported by the Institute for Healthcare Policy and Innovation Clinician Scholars Program and the National Institutes of Health (5T32HS000053-29)

References (24)

  • GR. Bauer

    Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity

    Soc Sci Med

    (2014)

  • Realizing the promise of equity in the organ transplantation system

    (2022)

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