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Racial Differences in Waiting List Outcomes in Chronic Obstructive Pulmonary Disease

¹ Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Departments of ² Biostatistics and ³ Epidemiology, Columbia University Mailman School of Public Health, New York, New York; and ⁴ Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York

Correspondence and requests for reprints should be addressed to David J. Lederer, M.D., M.S., Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH-8, Room 101, New York, NY 10032. E-mail: dl427{at}columbia.edu

Rationale: Blacks with chronic illness have poorer outcomes than whites in the United States. The health outcomes of minorities with chronic obstructive pulmonary disease (COPD) on the lung transplant waiting list have not been studied.

Objectives: To compare outcomes of black and white patients with COPD after listing for lung transplantation in the United States.

Methods: Retrospective cohort study of all 280 non-Hispanic black and 5,272 non-Hispanic white adults 40 years and older with COPD listed for lung transplantation in the United States between 1995 and 2004.

Measurements and Main Results: Blacks with COPD were more likely to have pulmonary hypertension, obesity, and diabetes; to lack private health insurance; and to live in poorer neighborhoods than whites. Blacks were less likely to undergo transplantation after listing compared with whites, despite adjustment for age, lung function, pulmonary hypertension, cardiovascular risk factors, insurance coverage, and poverty level (adjusted hazard ratio, 0.83; 95% confidence interval, 0.70–0.98; P = 0.03). This was accompanied by a greater risk of dying or being removed from the list among blacks (unadjusted hazard ratio, 1.31; 95% confidence interval, 1.05–1.63; P = 0.02).

Conclusions: After listing for lung transplantation, black patients with COPD were less likely to undergo transplantation and more likely to die or be removed from the list compared with white patients. Unequal access to care may have contributed to these differences.

Key Words: racial disparities • lung transplantation • survival • competing risks • black or African American

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject The mortality rate for blacks with chronic obstructive pulmonary disease (COPD) is rising faster than that of whites in the United States. The waiting list outcomes of blacks with COPD have not been studied. What This Study Adds to the Field Blacks with COPD on the waiting list for lung transplantation are less likely to undergo transplantation than whites with COPD in the United States.