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Dokollari A, Sicouri S, Hosseinian L, Erten O, Ramlawi B, Bisleri G, Bonacchi M, Sicouri N, Torregrossa G, Sutter FP. Periprocedural Risk Predictors Affecting Long-Term Prognosis in Patients With Chronic Obstructive Pulmonary Disease Undergoing Coronary Artery Bypass Grafting. Tex Heart Inst J 2024; 51:e238199. [PMID: 38494437 PMCID: PMC11075519 DOI: 10.14503/thij-23-8199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVE This study sought to identify periprocedural risk predictors that affect long-term prognosis in patients with chronic obstructive pulmonary disease (COPD) undergoing isolated coronary artery bypass grafting (CABG). METHODS All consecutive 4,871 patients undergoing isolated CABG between May 2005 and June 2021 were included. Patients with and without COPD were compared for baseline demographics and preoperative characteristics. A propensity-matched analysis was used to compare the 2 groups. The primary outcome was long-term incidence of all-cause death. RESULTS After matching, 767 patients each were included in the COPD and non-COPD groups; mean age was 71.6 and 71.4 years (P = .7), respectively; 29.3% and 32% (P = .2) were women, respectively. Intraoperatively, median (IQR) operating room time was higher in the COPD group than in the non-COPD group (5.9 [5.2-7.0] hours vs 5.8 [5.1-6.7] hours, respectively; P = .01). Postoperatively, intensive care unit stay (P = .03), hospital length of stay (P = .0004), and fresh frozen plasma transfusion units (P = .012) were higher in the COPD group than in the non-COPD group. Thirty-day mortality was not different between groups (1.3% in the COPD group vs 1% in the non-COPD group; P = .4). Median follow-up time was 4.0 years. The rate of all-cause death was higher in the COPD group than in the non-COPD group (138 patients [18.3%] vs 109 patients [14.5%], respectively; P = .042). Periprocedural risk predictors for all-cause death in patients with COPD were atrial fibrillation, diabetes, male sex, dialysis, ejection fraction less than 50%, peripheral vascular disease, and Society of Thoracic Surgeons Predicted Risk of Mortality score greater than 4%. CONCLUSION Patients with COPD undergoing isolated CABG had a significantly higher incidence of all-cause death than those without COPD. Herein, risk predictors are provided for all-cause death in patients undergoing isolated CABG.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
| | - Leila Hosseinian
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Ozgun Erten
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Gianluigi Bisleri
- Cardiac Surgery Department, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Noah Sicouri
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Gianluca Torregrossa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Francis P. Sutter
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
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David SV, Gibson D, Villasante-Tezanos A, Alzweri L, Hernández-Pérez JG, Torres-Sánchez LE, Baillargeon J, Lopez DS. Association of serum testosterone with chronic obstructive pulmonary disease (COPD) in a nationally representative sample of White, Black, and Hispanic men. Hormones (Athens) 2024; 23:153-162. [PMID: 38064143 PMCID: PMC10922908 DOI: 10.1007/s42000-023-00506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/07/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The association between total testosterone (T) and chronic obstructive pulmonary disease (COPD), remains poorly understood. We aim to investigate this association and how it varies by smoking status, body fatness, and race/ethnicity in a nationally representative sample of American men. METHODS Data included a full sample (NHANES 1988-1991, 1999-2004, 2011-2012) and subset sample (excluding 2011-2012, no estradiol and SHBG levels available) of 2748 and 906 men (≥20 years), respectively. COPD was measured by self-report or spirometry test. Total T (ng/mL) was measured among men who participated in a morning examination session. Weighted multivariable-adjusted logistic regression models were conducted. RESULTS Low T was positively associated with self-reported COPD in the full sample (OR = 2.10, 95% CI = 1.18-3.74, Ptrend = 0.010), and when stratified by current smokers and body fatness. When examined across race and ethnicity strata, this association persisted among White men (OR = 2.50, 95% CI = 1.30-4.79, Ptrend = 0.002) but not among Hispanic or Black men. In the subset sample, low T was positively associated with self-reported COPD (OR = 1.42, 95% CI, 0.57,3.55, Ptrend = 0.04), including among smokers and White men, but not body fatness. No significant associations were observed with COPD defined with spirometry plus self-report. CONCLUSION Low levels of T were associated with an increased prevalence of self-reported COPD in the full and subset samples. Similar associations were observed after stratifying by smoking status, body fatness, and race/ethnicity in the full sample and subset sample. Prospective studies are warranted to confirm these significant associations among understudied and underserved populations.
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Affiliation(s)
- Samuel V David
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA.
| | - Derrick Gibson
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA
| | - Alejandro Villasante-Tezanos
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA
| | - Laith Alzweri
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Jacques Baillargeon
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA
| | - David S Lopez
- School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1153, USA.
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Florissi I, Chidi AP, Liu Y, Ruck JM, Mauney C, McAdams-DeMarco M, Merlo CA, Shah P, Stewart DE, Segev DL, Bush EL. Racial Disparities in Waiting List Outcomes of Patients Listed for Lung Transplantation. Ann Thorac Surg 2024; 117:619-626. [PMID: 37673311 PMCID: PMC10924067 DOI: 10.1016/j.athoracsur.2023.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/08/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The Lung Allocation Score, implemented in 2005, prioritized lung transplant candidates by medical urgency rather than waiting list time and was expected to improve racial disparities in transplant allocation. We evaluated whether racial disparities in lung transplant persisted after 2005. METHODS We identified all wait-listed adult lung transplant candidates in the United States from 2005 through 2021 using the Scientific Registry of Transplant Recipients. We evaluated the association between race and receipt of a transplant by using a multivariable competing risk regression model adjusted for demographics, socioeconomic status, Lung Allocation Score, clinical measures, and time. We evaluated interactions between race and age, sex, socioeconomic status, and Lung Allocation Score. RESULTS We identified 33,158 candidates on the lung transplant waiting list between 2005 and 2021: 27,074 White (82%), 3350 African American (10%), and 2734 Hispanic (8%). White candidates were older, had higher education levels, and had lower Lung Allocation Scores (P < .001). After multivariable adjustment, African American and Hispanic candidates were less likely to receive lung transplants than White candidates (African American: adjusted subhazard ratio, 0.86; 95% CI, 0.82-0.91; Hispanic: adjusted subhazard ratio, 0.82; 95% CI, 0.78-0.87). Lung transplant was significantly less common among Hispanic candidates aged >65 years (P = .003) and non-White candidates from higher-poverty communities (African-American: P = .013; Hispanic: P =.0036). CONCLUSIONS Despite implementation of the Lung Allocation Score, racial disparities persisted for wait-listed African American and Hispanic lung transplant candidates and differed by age and poverty status. Targeted interventions are needed to ensure equitable access to this life-saving intervention.
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Affiliation(s)
- Isabella Florissi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexis P Chidi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yi Liu
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carrinton Mauney
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mara McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Christian A Merlo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Pali Shah
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Darren E Stewart
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Errol L Bush
- Division of Thoracic Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
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Enumah ZO, Etchill EW, Kim BS, Giuliano KA, Kalra A, Cho SM, Whitman GJR, Ha JS, Choi CW, Higgins RSD, Bush EL. Racial disparities among patients on venovenous extracorporeal membrane oxygenation in the pre-Coronavirus Disease 2019 and Coronavirus Disease 2019 eras: A retrospective registry review. JTCVS OPEN 2024; 17:162-171. [PMID: 38420563 PMCID: PMC10897667 DOI: 10.1016/j.xjon.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/06/2023] [Accepted: 12/10/2023] [Indexed: 03/02/2024]
Abstract
Objectives Although many studies have addressed such disparities caused by COVID-19, to our knowledge, no study has focused on the association of race on outcomes for patients with COVID-19 requiring venovenous extracorporeal membrane oxygenation support. The goal of this study was to assess association of race on death and duration on venovenous extracorporeal membrane oxygenation in both the pre-COVID-19 and COVID-19 eras. Methods We retrospectively reviewed the Extracorporeal Life Support Organization registry and included adults (≥18 years) who required venovenous extracorporeal membrane oxygenation between January 2019 and April 2021. We performed descriptive statistics and multivariable logistic regression. Our primary outcomes were death and extracorporeal membrane oxygenation duration. Results A total of 7477 patients were included after excluding 340 patients (4.3%) who were missing race data. In the COVID-19 era, 1474 of 2777 COVID-19-positive patients (53.1%) died. Our regression model suggested somewhat of a protective effect on death for Black and multiple race patients. Additionally, a diagnosis of COVID-19 and patients in the COVID-19 era in general, irrespective of COVID-19 diagnosis, had higher odds of death. Hispanic patients had the longest average venovenous extracorporeal membrane oxygenation run times. Conclusions Our study using data from the international Extracorporeal Life Support Organization Registry provides updated data on patients supported with venovenous extracorporeal membrane oxygenation in the pre-COVID-19 and COVID-19 eras between 2019 and 2021 with a focus on race. Patients in the COVID-19 era group also had higher mortality compared with those in the pre-COVID-19 era even after being adjusted for COVID-19 diagnosis. Black and multiple races appeared somewhat protective in terms of death. Hispanic race was associated with longer venovenous extracorporeal membrane oxygenation duration.
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Affiliation(s)
| | - Eric W Etchill
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Bo Soo Kim
- Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
| | | | - Andrew Kalra
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Sung-Min Cho
- Neurocritical Care, Johns Hopkins Hospital, Baltimore, Md
| | | | - Jinny S Ha
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Chun Woo Choi
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | | | - Errol L Bush
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
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Non AL, Bailey B, Bhatt SP, Casaburi R, Regan EA, Wang A, Limon A, Rabay C, Diaz AA, Baldomero AK, Kinney G, Young KA, Felts B, Hand C, Conrad DJ. Race-Specific Spirometry Equations Do Not Improve Models of Dyspnea and Quantitative Chest CT Phenotypes. Chest 2023; 164:1492-1504. [PMID: 37507005 PMCID: PMC10925545 DOI: 10.1016/j.chest.2023.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Race-specific spirometry reference equations are used globally to interpret lung function for clinical, research, and occupational purposes, but inclusion of race is under scrutiny. RESEARCH QUESTION Does including self-identified race in spirometry reference equation formation improve the ability of predicted FEV1 values to explain quantitative chest CT abnormalities, dyspnea, or Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification? STUDY DESIGN AND METHODS Using data from healthy adults who have never smoked in both the National Health and Nutrition Survey (2007-2012) and COPDGene study cohorts, race-neutral, race-free, and race-specific prediction equations were generated for FEV1. Using sensitivity/specificity, multivariable logistic regression, and random forest models, these equations were applied in a cross-sectional analysis to populations of individuals who currently smoke and individuals who formerly smoked to determine how they affected GOLD classification and the fit of models predicting quantitative chest CT phenotypes or dyspnea. RESULTS Race-specific equations showed no advantage relative to race-neutral or race-free equations in models of quantitative chest CT phenotypes or dyspnea. Race-neutral reference equations reclassified up to 19% of Black participants into more severe GOLD classes, while race-neutral/race-free equations may improve model fit for dyspnea symptoms relative to race-specific equations. INTERPRETATION Race-specific equations offered no advantage over race-neutral/race-free equations in three distinct explanatory models of dyspnea and chest CT scan abnormalities. Race-neutral/race-free reference equations may improve pulmonary disease diagnoses and treatment in populations highly vulnerable to lung disease.
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Affiliation(s)
- Amy L Non
- Department of Anthropology, University of California San Diego, La Jolla, CA
| | - Barbara Bailey
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Elizabeth A Regan
- Division of Rheumatology and Department of Medicine, National Jewish Health, Denver, CO
| | - Angela Wang
- Department of Medicine, University of California San Diego, La Jolla, CA
| | | | - Chantal Rabay
- Department of Anthropology, University of California San Diego, La Jolla, CA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Arianne K Baldomero
- Pulmonary, Allergy, Critical Care and Sleep Medicine Section, Minneapolis VA Health Care System, Minneapolis, MN
| | - Greg Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ben Felts
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA
| | - Carol Hand
- Advanced Mathematical Computing, San Diego, CA
| | - Douglas J Conrad
- Department of Medicine, University of California San Diego, La Jolla, CA.
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Krishnan JK, Mallya SG, Nahid M, Baugh AD, Han MK, Aronson KI, Goyal P, Pinheiro LC, Banerjee S, Martinez FJ, Safford MM. Disparities in Guideline Concordant Statin Treatment in Individuals With Chronic Obstructive Pulmonary Disease. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:369-379. [PMID: 37410623 PMCID: PMC10699489 DOI: 10.15326/jcopdf.2023.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
Rationale Cardiovascular disease (CVD) affects the prognosis of patients with chronic obstructive pulmonary disease (COPD). Black women with COPD have a disproportionate risk of CVD-related mortality, yet disparities in CVD prevention in COPD are unknown. Objectives We aimed to identify race-sex differences in the receipt of statin treatment for CVD prevention, and whether these differences were explained by factors influencing health care utilization in the REasons for Geographic And Racial Differences in Stroke (REGARDS) COPD study sub-cohort. Methods We conducted a cross-sectional analysis among REGARDS Medicare beneficiaries with COPD. Our primary outcome was the presence of statin on in-home pill bottle review among individuals with an indication. Prevalence ratios (PR) for statin treatment among race-sex groups compared to White men were estimated using Poisson regression with robust variance. We then adjusted for covariates previously shown to impact health care utilization. Results Of the 2032 members within the COPD sub-cohort with sufficient data, 1435 participants (19% Black women, 14% Black men, 28% White women, and 39% White men) had a statin indication. All race-sex groups were less likely to receive statins than White men in unadjusted models. After adjusting for covariates that influence health care utilization, Black women (PR 0.76, 95% confidence interval [CI] 0.67 to 0.86) and White women (PR 0.84 95% CI 0.76 to 0.91) remained less likely to be treated compared to White men. Conclusions All race-sex groups were less likely to receive statin treatment in the REGARDS COPD sub-cohort compared to White men. This difference persisted in women after controlling for individual health care utilization factors, suggesting structural interventions are needed.
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Affiliation(s)
- Jamuna K. Krishnan
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Sonal G. Mallya
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Musarrat Nahid
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Aaron D. Baugh
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Kerri I. Aronson
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Parag Goyal
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
- Division of Cardiology, Weill Cornell Medicine, New York, New York, United States
| | - Laura C. Pinheiro
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
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Brems JH, Balasubramanian A, Psoter KJ, Shah P, Bush EL, Merlo CA, McCormack MC. Race-Specific Interpretation of Spirometry: Impact on the Lung Allocation Score. Ann Am Thorac Soc 2023; 20:1408-1415. [PMID: 37315331 PMCID: PMC10559135 DOI: 10.1513/annalsats.202212-1004oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
Rationale: Interpretation of spirometry using race-specific reference equations may contribute to health disparities via underestimation of the degree of lung function impairment in Black patients. The use of race-specific equations may differentially affect patients with severe respiratory disease via the use of percentage predicted forced vital capacity (FVCpp) when included in the lung allocation score (LAS), the primary determinant of priority for lung transplantation. Objectives: To determine the impact of a race-specific versus a race-neutral approach to spirometry interpretation on the LAS among adults listed for lung transplantation in the United States. Methods: We developed a cohort from the United Network for Organ Sharing database including all White and Black adults listed for lung transplantation between January 7, 2009, and February 18, 2015. The LAS at listing was calculated for each patient under race-specific and race-neutral approaches, using the FVCpp generated from the Global Lung Function Initiative equation corresponding to each patient's race (race-specific) or from the Global Lung Function Initiative "other" (race-neutral) equation. Differences in LAS between approaches were compared by race, with positive values indicating a higher LAS under the race-neutral approach. Results: In this cohort of 8,982 patients, 90.3% were White and 9.7% were Black. The mean FVCpp was 4.4% higher versus 3.8% lower among White versus Black patients (P < 0.001) under a race-neutral compared with a race-specific approach. Compared with White patients, Black patients had a higher mean LAS under both a race-specific (41.9 vs. 43.9; P < 0.001) and a race-neutral (41.3 vs. 44.3; P < 0.001) approach. However, the mean difference in LAS under a race-neutral approach was -0.6 versus +0.6 for White versus Black patients (P < 0.001). Differences in LAS under a race-neutral approach were most pronounced for those in group B (pulmonary vascular disease) (-0.71 vs. +0.70; P < 0.001) and group D (restrictive lung disease) (-0.78 vs. +0.68; P < 0.001). Conclusions: A race-specific approach to spirometry interpretation has potential to adversely affect the care of Black patients with advanced respiratory disease. Compared with a race-neutral approach, a race-specific approach resulted in lower LASs for Black patients and higher LASs for White patients, which may have contributed to racially biased allocation of lung transplantation. The future use of race-specific equations must be carefully considered.
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Affiliation(s)
- J. Henry Brems
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Kevin J. Psoter
- Division of General Pediatrics, Department of Pediatrics, and
| | - Pali Shah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Errol L. Bush
- Division of Thoracic Surgery, Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Christian A. Merlo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
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Bonner SN, Thumma JR, Valbuena VSM, Stewart JW, Combs M, Lyu D, Chang A, Lin J, Wakeam E. The intersection of race and ethnicity, gender, and primary diagnosis on lung transplantation outcomes. J Heart Lung Transplant 2023; 42:985-992. [PMID: 36967318 PMCID: PMC11258797 DOI: 10.1016/j.healun.2023.02.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 01/10/2023] [Accepted: 02/18/2023] [Indexed: 03/05/2023] Open
Abstract
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.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan.
| | - Jyothi R Thumma
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Valeria S M Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan
| | - James W Stewart
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan; Department of Surgery, Yale University, New Haven, Connecticut
| | - Michael Combs
- Department of Internal Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan
| | - Dennis Lyu
- Department of Internal Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan
| | - Andrew Chang
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jules Lin
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Elliot Wakeam
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
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Hadjiliadis D, Valapour M, Chaparro C, Cypel M, Cooper JD. The 49th parallel: Does geographic position affect longevity of patients with cystic fibrosis? J Thorac Cardiovasc Surg 2023; 165:1604-1607. [PMID: 35365362 DOI: 10.1016/j.jtcvs.2022.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/04/2021] [Accepted: 01/23/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Denis Hadjiliadis
- Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, Pa
| | | | - Cecilia Chaparro
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Department of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joel D Cooper
- Division of Thoracic Surgery, School of Medicine, University of Pennsylvania, Philadelphia, Pa.
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Urinary polycyclic aromatic hydrocarbon, arsenic, and metal exposure and correlation with emphysema in smokers. Toxicol Appl Pharmacol 2022; 450:116168. [PMID: 35842137 DOI: 10.1016/j.taap.2022.116168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Environmental exposure to metals and chemicals can increase the risk of acute and chronic pulmonary diseases in the human population. This study aimed to analyze seven forms of polycyclic aromatic hydrocarbons (PAHs), seven types of arsenic species, fourteen types of urinary metals including antimony, barium, cadmium, cesium, cobalt, lead, manganese, mercury, molybdenum, strontium, thallium, tin, tungsten, uranium, and the link with emphysema in the US adult cigarette smoking population. METHODS A specialized weighted complex survey design analysis using 2011-2016 National Health and Nutrition Examination Survey (NHANES) datasets was conducted. Multivariate logistic regression models were used to assess the association between urinary metals, arsenic, PAHs, and emphysema in adult smokers. R software was used to conduct the statistical analysis. RESULTS All 4th quantile concentrations of PAHs, including 1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene, 1-hydroxypyrene, 1-hydroxyphenanthrene, and 2 & 3-hydroxyphenanthrene, were significantly associated with emphysema in smokers. The 3rd quantile of 1-hydroxypyrene were also associated with increased odds of emphysema in smokers. Among arsenic and metals, the 4th quantile of cadmium was associated with an increased odds of emphysema in smokers. The 3rd quantile of dimethylarsinic acid (DMA) and 4th quantile of mercury were found to have inverse relationships with emphysema in smokers. Several demographic factors had significant associations with emphysema in smokers. CONCLUSION Urinary PAHs and cadmium were associated with increased odds of emphysema in smokers. DMA and mercury had an inverse association with emphysema in smokers.
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11
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Schluger NW. The Vanishing Rationale for the Race Adjustment in Pulmonary Function Test Interpretation. Am J Respir Crit Care Med 2022; 205:612-614. [PMID: 35085469 DOI: 10.1164/rccm.202112-2772ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Neil W Schluger
- New York Medical College, 8137, Medicine, Valhalla, New York, United States;
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12
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Abstract
Since the initial report of long-term survival after lung transplantation (LT) in 1983, there has been remarkable progress in the field and LT is now the gold-standard therapy for patients with end-stage lung disease. It confers a significant survival advantage and improves the quality of life in patients who often have few other treatment options. However, LT remains a complex undertaking and establishing and maintaining an LT program is resource intensive with multiple potential barriers. In this article, we focus on disparities in LT and the potential solutions to improving access to LT.
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Affiliation(s)
- Simran K Randhawa
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Sophia H Roberts
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Varun Puri
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA
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Riley LE, Lascano J. Gender and racial disparities in lung transplantation in the United States. J Heart Lung Transplant 2021; 40:963-969. [PMID: 34246564 DOI: 10.1016/j.healun.2021.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 04/20/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Lung transplant (LT) allocation utilizes a scoring system to prioritize patients, although data evaluating the access by gender and race remains limited. The study objective was to determine whether gender and racial disparities exist in patients listed for LT. METHODS This was a retrospective analysis using the Organ Procurement and Transplant Network database of patients listed for a LT from 1984 until 2019. Nominal multivariate logistic regression analysis was performed to evaluate LT allocation by gender, race, and primary lung disease. Kaplan-Meier curves were constructed to compare rates of mortality over time. RESULTS Sixty thousand eight hundred and forty-seven patients were listed between February 1984 and September 2019. Males comprised the majority of listed and transplanted patients at 51.7% and 55.8% respectively. In the LAS era, the median waiting list time for transplanted males was 43 days (interquartile range [IQR] 13-126), and females waited a median of 80 days (IQR 24-233) (p < .001). Persons of White race accounted for 82.6% and 84.3% of listed and transplanted patients respectively. Logistic regression analysis found that in the LAS era, males had an increased odds for LT allocation (OR 1.19, CI 1.12-1.27, p < .001) compared to females, and persons of White race (OR 1.23, CI 1.16-1.32, p < .001) compared to all other races combined. CONCLUSIONS The majority of listed and transplanted patients in the United States were males and persons of White race. Also, being a male or person of White race had an outcome favoring lung transplant allocation compared to an appropriately matched person of another gender or race.
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Affiliation(s)
- Leonard E Riley
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, Florida.
| | - Jorge Lascano
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, Florida
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Mitigating the Impact of Socioeconomic Status on Listing for Lung Transplantation in Cystic Fibrosis. Ann Am Thorac Soc 2020; 17:1374-1375. [PMID: 33124911 PMCID: PMC7640733 DOI: 10.1513/annalsats.202007-905ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Seay T, Guinn N, Maisonave Y, Fuller M, Poisson J, Pollak A, Bryner B, Haney J, Klapper J, Hartwig M, Bottiger B. The Association of Increased FFP:RBC Transfusion Ratio to Primary Graft Dysfunction in Bleeding Lung Transplantation Patients. J Cardiothorac Vasc Anesth 2020; 34:3024-3032. [PMID: 32622711 DOI: 10.1053/j.jvca.2020.05.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Lung transplantation is associated with a significant risk of needed transfusion. Although algorithm-based transfusion strategies that promote a high fresh frozen plasma:red blood cells (FFP:RBC) ratio have reduced overall blood product requirements in other populations, large-volume transfusions have been linked to primary graft dysfunction (PGD) in lung transplantation, particularly use of platelets and plasma. The authors hypothesized that in lung transplant recipients requiring large-volume transfusions, a higher FFP:RBC ratio would be associated with increased PGD severity at 72 hours. DESIGN Observational retrospective review. SETTING Single tertiary academic center. PARTICIPANTS Adult patients undergoing bilateral or single orthotopic lung transplantation and receiving >4 U PRBC in the first 72 hours from February 2014 to March 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patient demographics, operative characteristics, blood transfusions, and outcomes including PGD scores and length of stay were collected. Eighty-nine patients received >4U PRBC, had available 72-hour PGD data, and were included in the study. These patients were grouped into a high-ratio (>1:2 units of FFP:RBC, N = 38) or low-ratio group (<1:2 units of FFP:RBC, N = 51). Patients in the high-ratio group received more transfusions and factor concentrates and had significantly longer case length. The high-ratio group had a higher rate of severe PGD at 72 hours (60.5% v 23.5%, p = 0.0013) and longer hospital length of stay (40 v 32 days, p = 0.0273). CONCLUSIONS In bleeding lung transplantation patients at high risk for PGD, a high FFP:RBC transfusion ratio was associated with worsened 72-hour PGD scores when compared with the low-ratio cohort.
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Affiliation(s)
- Theresa Seay
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
| | - Nicole Guinn
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Yasmin Maisonave
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Matt Fuller
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Jessica Poisson
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Angela Pollak
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Ben Bryner
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - John Haney
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jacob Klapper
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Matthew Hartwig
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Brandi Bottiger
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
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Mindlis I, Livert D, Federman AD, Wisnivesky JP, Revenson TA. Racial/ethnic concordance between patients and researchers as a predictor of study attrition. Soc Sci Med 2020; 255:113009. [PMID: 32371270 DOI: 10.1016/j.socscimed.2020.113009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/31/2020] [Accepted: 04/19/2020] [Indexed: 11/25/2022]
Abstract
RATIONALE The differential attrition of racial/ethnic minority participants in clinical research is a major threat to advancing medical and behavioral science. OBJECTIVE Our aim was to examine the influence of racial/ethnic concordance between participants and research staff on study attrition. METHOD Data were pooled from participants and clinical research coordinators (CRCs) in six longitudinal studies of respiratory illness. Dyads were classified as concordant if the patient and CRC were of the same racial/ethnic group. Multilevel modeling examined the effect of racial/ethnic concordance on attrition at the first and one-year follow-ups. RESULTS Spanish language, lower education, and greater depressive symptoms predicted greater attrition, but these effects disappeared in adjusted models. Race/ethnicity, age, gender and health literacy did not predict attrition. Contrary to hypotheses, attrition was greater among concordant than discordant dyads: Attrition was almost five times greater at first follow-up for Black and Hispanic participants in concordant dyads, and almost four times greater at one year. CONCLUSIONS Racial/ethnic concordance between participant and CRCs was related to greater attrition in a highly diverse sample of adults with respiratory illness. Differential attrition of racial/ethnic minorities is a major threat to advancing public health. Interactions with research staff may be critical to bridging the disparities gap.
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Affiliation(s)
- Irina Mindlis
- Psychology Department, The Graduate Center, City University of New York, NY, USA.
| | - David Livert
- Psychology Department, Penn State Lehigh Valley, PA, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Tracey A Revenson
- Psychology Department, The Graduate Center, City University of New York, NY, USA; Psychology Department, Hunter College, City University of New York, NY, USA
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Sweet SC. Assessing the impact of program volume and composition on waiting list outcomes in pediatric lung transplantation. J Heart Lung Transplant 2017; 36:1180-1182. [DOI: 10.1016/j.healun.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 06/20/2017] [Indexed: 11/29/2022] Open
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Mooney JJ, Hedlin H, Mohabir P, Bhattacharya J, Dhillon GS. Racial and ethnic disparities in lung transplant listing and waitlist outcomes. J Heart Lung Transplant 2017; 37:394-400. [PMID: 29129372 DOI: 10.1016/j.healun.2017.09.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/30/2017] [Accepted: 09/26/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The United States lung transplant registry data demonstrate differences in adult waitlist mortality by race/ethnicity. It is unknown whether these differences persist after risk adjustment or occur secondary to disparities in disease severity at the time of listing. METHODS Adult lung transplant waitlist candidates between May 4, 2005 and March 5, 2015 were identified and compared by non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic and Asian race/ethnicity. A competing risk proportional hazards model was used to assess the association of race/ethnicity with the unadjusted and adjusted risk of waitlist death or removal for too sick, transplant, or removal for other reason. Disease illness severity at transplant listing was compared by race/ethnicity. RESULTS There were 20,684 lung transplant candidates identified (82% NHW, 9% NHB, 6% Hispanic, 2% Asian and 1% other). Non-white candidates had higher unadjusted waitlist mortality, which was fully mitigated by adjusting for other risk factors (NHB: hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.93 to 1.18; Hispanic: HR 1.02, 95% CI 0.99 to 1.18; Asian: HR 0.90, 95% CI 0.70 to 1.16). Adjusted waitlist access to transplant was lower in non-white candidates (NHB: HR 0.88, 95% CI 0.83 to 0.94; Hispanic: HR 0.87, 95% CI 0.81 to 0.94; Asian: HR 0.83, 95% CI 0.73 to 0.96). NHW candidates with obstructive lung disease and pulmonary fibrosis were older with less illness severity at listing than non-white candidates. CONCLUSIONS Within the current lung allocation system, there is no difference in risk-adjusted waitlist mortality by race/ethnicity, but non-white waitlist candidates have lower risk-adjusted access to lung transplant. Non-white candidates are generally younger with greater disease-specific illness severity at the time of lung transplant listing.
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Affiliation(s)
- Joshua J Mooney
- Department of Medicine, Division of Pulmonary and Critical Care, Stanford University, Stanford, California, USA.
| | - Haley Hedlin
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, California, USA
| | - Paul Mohabir
- Department of Medicine, Division of Pulmonary and Critical Care, Stanford University, Stanford, California, USA
| | - Jay Bhattacharya
- Department of Medicine, Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
| | - Gundeep S Dhillon
- Department of Medicine, Division of Pulmonary and Critical Care, Stanford University, Stanford, California, USA
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Increased Mortality in Adult Cystic Fibrosis Patients with Medicaid Insurance Awaiting Lung Transplantation. Lung 2016; 194:799-806. [DOI: 10.1007/s00408-016-9927-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 08/02/2016] [Indexed: 01/20/2023]
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21
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Mosca MS, Narotsky DL, Liao M, Mochari-Greenberger H, Beck J, Mongero L, Bacchetta M. Survival Following Veno-Venous Extracorporeal Membrane Oxygenation and Mortality in a Diverse Patient Population. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2015; 47:217-222. [PMID: 26834283 PMCID: PMC4730164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 11/29/2015] [Indexed: 06/05/2023]
Abstract
Racial and ethnic disparities in cardiovascular disease are well established; however, there is limited information about survival differences following veno-venous extracorporeal membrane oxygenation (VV-ECMO) in contemporary adult populations. The purpose of this study was to assess survival at discharge, 30 days, and at 1 year following institution of VV-ECMO in an ethnically diverse population, and to examine potential risk factors for mortality. This was a single-center study of 41 patients (49% female, 27% minorities, 7% > 65 years) who received VV-ECMO between the years 2004 and 2013 at an academic medical center. Kaplan-Meier estimates were calculated to assess survival up to 1 year, and cox proportional hazard models were used to evaluate the association between risk factors, mortality, and confounders. Overall, 76% (n = 31) of VV-ECMO patients survived to discharge and 30 days and 71% (n = 29) survived to 1 year. Whites (n = 30) had a higher survival at 1 year compared to minorities (n = 11) (83% vs. 36%, respectively, p = .01). Minorities had a significantly increased risk of mortality at 30 days (hazard ratio [HR] = 5.07, 95% confidence interval [CI] = 1.42-18.09) and at 1 year (HR = 5.19, 95% CI = 1.63-16.55). Race/ethnicity remained a significant independent predictor of survival at 30 days except when history of shock or lung transplantation was included in adjusted regression models. VV-ECMO was associated with an excellent overall survival up to 1 year. Racial/ethnic minorities had a 5-fold increased risk for 30-day mortality, which was largely explained by a lower likelihood of lung transplantation and increased risk of shock.
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Affiliation(s)
| | | | - Ming Liao
- Columbia University Medical Center, New York, New York
| | | | - James Beck
- Columbia University Medical Center, New York, New York
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Yusen RD, Lederer DJ. Disparities in lung transplantation. J Heart Lung Transplant 2013; 32:673-4. [PMID: 23796151 DOI: 10.1016/j.healun.2013.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 11/25/2022] Open
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Wille KM, Harrington KF, deAndrade JA, Vishin S, Oster RA, Kaslow RA. Disparities in lung transplantation before and after introduction of the lung allocation score. J Heart Lung Transplant 2013; 32:684-92. [PMID: 23582477 DOI: 10.1016/j.healun.2013.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 02/27/2013] [Accepted: 03/06/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In May 2005, the Lung Allocation Score (LAS) became the primary method for determining allocation of lungs for organ transplantation for those at least 12 years of age in the United States. During the pre-LAS period, black patients were more likely than white patients to become too sick or die while awaiting transplant. The association between gender and lung transplant outcomes has not been widely studied. METHODS Black and white patients aged ≥ 18 years registered on the United Network for Organ Sharing (UNOS) lung transplantation waiting list from January 1, 2000, to May 3, 2005 (pre-LAS, n = 8,765), and from May 4, 2005, to September 4, 2010 (LAS, n = 8,806), were included. Logistic regression analyses were based on smaller cohorts derived from patients listed in the first 2 years of each era (2,350 pre-LAS, and 2,446 LAS) to allow for follow-up time. Lung transplantation was the primary outcome measure. Multivariable analyses were performed within each interval to determine the odds that a patient would die or receive a lung transplant within 3 years of listing. RESULTS In the pre-LAS era, black patients were more likely than white patients to become too sick for transplantation or die within 3 years of waiting list registration (43.8% vs 30.8%; odds ratio [OR], 1.84; p < 0.001). Race was not associated with death or becoming too sick while listed for transplantation in the LAS era (14.0% vs 13.3%; OR, 0.93; p = 0.74). Black patients were less likely to undergo transplantation in the pre-LAS era (56.3% vs 69.2%; OR, 0.54; p < 0.001) but not in the LAS era (86.0% vs 86.7%; OR, 1.07; p = 0.74). Women were more likely than men to die or become too sick for transplantation within 3 years of listing in the LAS era (16.1% vs 11.3%; OR, 1.58; p < 0.001) compared with the pre-LAS era (33.4% vs 30.7%; OR, 1.19; p = 0.08). CONCLUSION Racial disparities in lung transplantation have decreased with the implementation of LAS as the method of organ allocation; however, gender disparities may have actually increased in the LAS era.
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Affiliation(s)
- Keith M Wille
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Efird JT, O'Neal WT, Anderson CA, O'Neal JB, Kindell LC, Ferguson TB, Chitwood WR, Kypson AP. The effect of race and chronic obstructive pulmonary disease on long-term survival after coronary artery bypass grafting. Front Public Health 2013; 1. [PMID: 24013365 PMCID: PMC3764432 DOI: 10.3389/fpubh.2013.00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a known predictor of decreased long-term survival after coronary artery bypass grafting (CABG). Differences in survival by race have not been examined. Methods: A retrospective cohort study was conducted of CABG patients between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Results: A total of 984 (20%) patients had COPD (black n = 182; white n = 802) at the time of CABG (N = 4,801). The median follow-up for study participants was 4.4 years. COPD was observed to be a statistically significant predictor of decreased survival independent of race following CABG (no COPD: HR = 1.0; white COPD: adjusted HR = 1.9, 95% CI = 1.7–2.3; black COPD: adjusted HR = 1.6, 95% CI = 1.1–2.2). Conclusion: Contrary to the expected increased risk of mortality among black COPD patients in the general population, a similar survival disadvantage was not observed in our CABG population.
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Affiliation(s)
- Jimmy T Efird
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; Center for Health Disparities Research, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Baldwin MR, Arcasoy SM, Shah A, Schulze PC, Sze J, Sonett JR, Lederer DJ. Hypoalbuminemia and early mortality after lung transplantation: a cohort study. Am J Transplant 2012; 12:1256-67. [PMID: 22335491 PMCID: PMC3628840 DOI: 10.1111/j.1600-6143.2011.03965.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hypoalbuminemia predicts disability and mortality in patients with various illnesses and in the elderly. The association between serum albumin concentration at the time of listing for lung transplantation and the rate of death after lung transplantation is unknown. We examined 6808 adults who underwent lung transplantation in the United States between 2000 and 2008. We used Cox proportional hazard models and generalized additive models to examine multivariable-adjusted associations between serum albumin and the rate of death after transplantation. The median follow-up time was 2.7 years. Those with severe (0.5-2.9 g/dL) and mild hypoalbuminemia (3.0-3.6 g/dL) had posttransplant adjusted mortality rate ratios of 1.35 (95% CI: 1.12-1.62) and 1.15 (95% CI: 1.04-1.27), respectively. For each 0.5 g/dL decrease in serum albumin concentration the 1-year and overall mortality rate ratios were 1.48 (95% CI: 1.21-1.81) and 1.26 (95% CI: 1.11-1.43), respectively. The association between hypoalbuminemia and posttransplant mortality was strongest in recipients with cystic fibrosis and interstitial lung disease. Hypoalbuminemia is an independent risk factor for death after lung transplantation.
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Affiliation(s)
- M. R. Baldwin
- Departments of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - S. M. Arcasoy
- Departments of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - A. Shah
- Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - P. C. Schulze
- Departments of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - J. Sze
- New York Presbyterian Hospital, New York, NY
| | - J. R. Sonett
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
| | - D. J. Lederer
- Departments of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY,Corresponding author: David J. Lederer,
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Liu V, Weill D, Bhattacharya J. Racial disparities in survival after lung transplantation. ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 2011; 146:286-93. [PMID: 21422359 PMCID: PMC10574511 DOI: 10.1001/archsurg.2011.4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
CONTEXT Racial disparities have not been comprehensively evaluated among recipients of lung transplantation. OBJECTIVES To describe the association between race and lung transplant survival and to determine whether racial disparities have changed in the modern (2001-2009) compared with the historical (1987-2000) transplant eras. DESIGN, SETTING, AND PATIENTS A retrospective cohort study of 16 875 adults who received primary lung transplants from October 16, 1987, to February 19, 2009, was conducted using data from the United Network of Organ Sharing. MAIN OUTCOME MEASURES We measured the risk of death after lung transplant for nonwhites compared with whites using time-to-event analysis. RESULTS During the study period, 14 858 white and 2017 nonwhite patients underwent a lung transplant; they differed significantly at baseline. The percentage of nonwhite transplant recipients increased from 8.8% (before 1996) to 15.0% (2005-2009). In the historical era, 5-year survival was lower for nonwhites than whites (40.9% vs 46.9%). Nonwhites were at an increased risk of death independent of age, health and socioeconomic status, diagnosis, geographic region, donor organ characteristics, and operative factors (hazard ratio, 1.15; 95% confidence interval, 1.01-1.30). In subgroup analysis of the historical era, blacks had worsened 5-year survival compared with whites (39.0% vs 46.9%) and black women had worsened survival compared with white women (36.9% vs 48.9%). In the modern transplant era, survival improved for all patients. However, a greater improvement among nonwhites has eliminated the disparities in survival between the races (5-year survival, 52.5% vs 51.6%). CONCLUSION In contrast to the historical era, there was no significant difference in lung transplant survival in the modern era between whites and nonwhites.
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Affiliation(s)
- Vincent Liu
- Division of Pulmonary and Critical Care Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Davies RR, Russo MJ, Hong KN, Mital S, Mosca RS, Quaegebeur JM, Chen JM. Increased Short- and Long-term Mortality at Low-volume Pediatric Heart Transplant Centers. Ann Surg 2011; 253:393-401. [DOI: 10.1097/sla.0b013e31820700cc] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Eisner MD, Blanc PD, Omachi TA, Yelin EH, Sidney S, Katz PP, Ackerson LM, Sanchez G, Tolstykh I, Iribarren C. Socioeconomic status, race and COPD health outcomes. J Epidemiol Community Health 2011; 65:26-34. [PMID: 19854747 PMCID: PMC3017471 DOI: 10.1136/jech.2009.089722] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although chronic obstructive pulmonary disease (COPD) is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race-ethnicity on health outcomes. METHODS The aim of this study is to determine the independent impacts of SES and race-ethnicity on COPD severity status, functional limitations and acute exacerbations of COPD among patients with access to healthcare. Data were used from the Function, Living, Outcomes and Work cohort study of 1202 Kaiser Permanente Northern California Medical Care Plan members with COPD. RESULTS Lower educational attainment and household income were consistently related to greater disease severity, poorer lung function and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index and occupational exposures). Lower education and lower income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively). CONCLUSION Low SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes.
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Affiliation(s)
- M D Eisner
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0111, USA.
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Davies RR, Russo MJ, Morgan JA, Sorabella RA, Naka Y, Chen JM. Standard versus bicaval techniques for orthotopic heart transplantation: An analysis of the United Network for Organ Sharing database. J Thorac Cardiovasc Surg 2010; 140:700-8, 708.e1-2. [DOI: 10.1016/j.jtcvs.2010.04.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 01/12/2010] [Accepted: 04/26/2010] [Indexed: 01/15/2023]
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Janssen DJ, Spruit MA, Does JD, Schols JM, Wouters EF. End-of-life care in a COPD patient awaiting lung transplantation: a case report. BMC Palliat Care 2010; 9:6. [PMID: 20426832 PMCID: PMC2873495 DOI: 10.1186/1472-684x-9-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 04/28/2010] [Indexed: 11/30/2022] Open
Abstract
COPD is nowadays the main indication for lung transplantation. In appropriately selected patients with end stage COPD, lung transplantation may improve quality of life and prognosis of survival. However, patients with end stage COPD may die while waiting for lung transplantation. Palliative care is important to address the needs of patients with end stage COPD. This case report shows that in a patient with end stage COPD listed for lung transplantation offering palliative care and curative-restorative care concurrently may be problematic. If the requirements to remain a transplantation candidate need to be met, the possibilities for palliative care may be limited. Discussing the possibilities of palliative care and the patient's treatment preferences is necessary to prevent that end-of-life care needs of COPD patients dying while listed for lung transplantation are not optimally addressed. The patient's end-of-life care preferences may ask for a clear distinction between the period in which palliative and curative-restorative care are offered concurrently and the end-of-life care period. This may be necessary to allow a patient to spend the last stage of life according to his or her wishes, even when this implicates that lung transplantation is not possible anymore and the patient will die because of end stage COPD.
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Affiliation(s)
- Daisy Ja Janssen
- Program Development Centre, Ciro, centre of expertise for chronic organ failure, Horn, the Netherlands.
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Allen JG, Weiss ES, Merlo CA, Baumgartner WA, Conte JV, Shah AS. Impact of Donor–Recipient Race Matching on Survival After Lung Transplantation: Analysis of Over 11,000 Patients. J Heart Lung Transplant 2009; 28:1063-71. [DOI: 10.1016/j.healun.2009.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 06/11/2009] [Accepted: 06/12/2009] [Indexed: 02/07/2023] Open
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Bibliography. Current world literature. Curr Opin Pulm Med 2009; 15:170-7. [PMID: 19225311 DOI: 10.1097/mcp.0b013e3283276f69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 November 2007 and 31 October 2008 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.
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Affiliation(s)
- Vibha N Lama
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan School of Medicine, 1500 E. Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109-0360, USA.
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Lingaraju R, Pochettino A, Blumenthal NP, Mendez J, Lee J, Christie JD, Kotloff RM, Ahya VN, Hadjiliadis D. Lung transplant outcomes in white and African American recipients: special focus on acute and chronic rejection. J Heart Lung Transplant 2009; 28:8-13. [PMID: 19134524 DOI: 10.1016/j.healun.2008.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 10/22/2008] [Accepted: 10/22/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The effects of lung transplant recipient race on post-transplant outcomes have not been adequately evaluated. This cohort study seeks to determine the characteristics of African American lung transplant recipients and the effects of African American race on post-transplant outcomes, particularly acute and chronic rejection, compared with white recipients, at a single center. METHODS There were 485 first-time lung transplantations (431 white, 47 African American, 5 Hispanic and 2 Asian recipients) performed at the University of Pennsylvania between 1991 and 2006. All white and African American recipients were compared based on pre-transplant diagnoses and post-transplant survival. The cohort from 1998 to 2006 (239 white and 25 African American recipients) was also compared based on acute rejection score (ARS) and development of bronchiolitis obliterans syndrome (BOS). RESULTS Chronic obstructive pulmonary disease was the most common diagnosis leading to lung transplantation in both groups, but sarcoidosis was a much more common indication in African American recipients (white, 1%; African American, 28%; p < 0.001). Survival was similar in the two groups (white vs African American groups: 1 month, 90.0% vs 87.2%; 1 year, 74.9% vs 74.5%; 5 years, 52.3% vs 50.5%, respectively; p = 0.84). Freedom from BOS at 3 years (white, 60.3%; African American, 62.8%; p = 0.30) and ARS per biopsy (white, 0.83 +/- 0.82; African American, 0.63 +/- 0.77; p = 0.31) were similar in both groups. CONCLUSIONS White and African American patients seek lung transplantation for different diseases, but post-transplant outcomes were found to be similar. Larger, multi-center studies are needed to confirm these results.
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Affiliation(s)
- Rajiv Lingaraju
- Division of Pulmonary/Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Muula A. The impact of race on severity of uterine leiomyomata. Am J Obstet Gynecol 2008; 199:e12; author reply e12-3. [PMID: 18691692 DOI: 10.1016/j.ajog.2008.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
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Pondrom S. The AJT Report. News and issues that affect organ and tissue transplantation. Am J Transplant 2008; 8:1357-8. [PMID: 18651875 DOI: 10.1111/j.1600-6143.2008.02330.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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