Patients in small towns and isolated rural areas have lower organ transplant rates and are less likely to be wait-listed than patients in urban areas, according to a study in the January 9/16 issue of JAMA.
Organ transplantation offers the best, and often only hope for long-term survival for patients with end-stage heart, liver, and kidney disease. However, despite federal regulation and national efforts to ensure equal access to the limited pool of donated organs, previous research has demonstrated the presence of significant barriers to access to transplantation services for racial minorities, women, and patients with low socioeconomic status or poor insurance, according to background information in the article. Rural residents represent another group that may have impaired access to transplant services. Nearly 14 percent of the U.S. population lives outside major urban areas.
David A. Axelrod, M.D., M.B.A., of Dartmouth Medical School, Lebanon, N.H., and colleagues assessed the impact of rural residence on waiting list registration for heart, liver, and kidney transplant and rates of transplantation among wait-listed candidates. A total of 174,630 patients who were wait-listed and who underwent heart, liver, or kidney transplantation between 1999 and 2004 were included in the study.
The researchers found significant disparities in access to organ transplantation between rural and urban populations.
"This study demonstrates that patients living in small towns and isolated rural regions were eight percent to 15 percent less likely to be wait-listed and ten percent to 20 percent less likely to undergo heart, liver, and kidney transplantation than patients in urban environments," the authors write.
They suggest these discrepancies may be related to differences in the burden of disease in rural environments or reduced access to entering the waiting list. And they warn that the increasing concentration of transplant services in high-volume urban centers may lead to increased access barriers for rural patients.
"Further assessment of the disease burden facing rural residents and the barriers in access to specialty care services is needed to ensure equitable access to life-saving organ transplants," the researchers conclude.
(JAMA. 2008;299(2):202-208. Available pre-embargo to the media at www.jamamedia.org)
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