Abstract 17340: Disparities in Wait Times for Heart Transplant by Racial and Ethnic Minorities

Abstract

Introduction: Although wait times vary widely across geographic regions and blood type under the current allocation system, it is unclear if minority patients have longer waitlist times. Hypothesis: We hypothesized that racial/ethnic minority patients experience longer wait times to transplant, even after accounting for age, gender, blood type, heart failure severity defined by UNOS status, and region. Methods: Patients listed for first transplant from 2005-2016 in the UNOS database were analyzed by racial/ethnic groups: African-American (AA), Hispanic, White (Non-Hispanic) and Other. We estimated median time to transplant for each group by year of listing using cumulative incidence functions and accounted for competing risks of waitlist mortality and delisting. For 2015-2016, we performed multivariable cause-specific Cox regression modeling accounting for age, gender, UNOS status urgency (status 1A, 1B, 2, 7) ABO blood type, and region by organ procurement organization. The reference population was Whites. Results: A total of 36,801 patients (21.5% AA, 7.8% Hispanic, 4.0% Other and 66.6% White) were available for analysis. Since 2005, the proportion of AAs on the waitlist has increased slightly, while the proportion of Whites has decreased. Wait times increased to a peak in 2014 for all ethnic/racial groups, but were disproportionally increased for AAs. In 2015-2016 this disparity persisted but was less pronounced compared to prior years. ( Figure ) After multivariable adjustment, the Hazard Ratio for time to transplant in AAs was 0.90 (95% CI 0.83 – 0.96) compared to Whites, with no prolonged time to transplant for other minorities. Conclusions: AAs experience disproportionally long wait times for heart transplant, which could not be explained by traditional determinants of time to transplant. How the new allocation system implemented in 2018 will impact this disparity should be a focus for ongoing population health research.