Insurance Type and Impact on Waitlist Mortality in Young Heart Transplant Candidates: A UNOS Registry Analysis

D. A. Magnetta, P. T. Thrush, M. C. Monge, A. Khan, E. Pahl

Research output: Contribution to journalArticle


PURPOSE: Public insurance increasingly funds adult heart transplants but does not impact their waitlist mortality. Insurance trends and their impact on waitlist mortality are not yet described in children. METHODS: Using the OPTN/UNOS database, we described characteristics of pediatric (<18 years) and young adult (18-26 years) heart transplant candidates in three 5-year eras ('03-'08; '08-'13; '13-'18). Waitlist mortality was analyzed by competing outcomes analysis. Risk factors for mortality were identified using competing risks regression. RESULTS: We identified 10,466 pediatric (79%) and young adult (21%) candidates. The proportion of pediatric patients covered by public insurance (mostly Medicaid) increased (Figure 1, p<0.001). This trend persisted in all pediatric age groups and diagnoses. In contrast, young adults used more private insurance from Era 1 to Era 2 (p=0.001). Though public insurance increased in both white and black candidates, insurance was predominantly private in white candidates and public in black candidates. Waitlist mortality decreased across eras (subdistribution hazard ratio [SHR] 0.86, p<0.001); however public health insurance at listing was associated with increased waitlist mortality after adjusting for era (SHR 1.19, p=0.001, Figure 2). CONCLUSION: Pediatric heart transplant candidates are increasingly covered by public health insurance. Despite lower waitlist mortality overall, public health insurance at listing is associated with inferior waitlist survival. These results differ significantly from data in adult candidates and warrant further investigation.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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