A STATEWIDE, POPULATION-BASED, TIME-SERIES ANALYSIS OF ACCESS TO LIVER-TRANSPLANTATION

While the number of patients listed for liver transplant has increased , the pool of donor organs has remained constant. Questions have arise n regarding equitable access to organs. The purpose of this study was to analyze factors associated with access to liver transplantation (LT ) using a large, population-based, hospital discharge database. The pr imary hypothesis was that a variety of factors other than medical need could be associated with access to LT. The rate of LT was defined as the number of Liver transplants per admission for liver disease. The d ata sources were selected to allow a population-based, time-series ana lysis of all patients admitted with liver disease and those receiving liver transplants in all 157 nonfederal hospitals in North Carolina fr om 1988 to 1993. The hypotheses of this study were that age, gender, p ayment source, type of liver disease, distance from the transplant cen ter, and rural county of residence were associated with patients' like lihood of access to LT, During the six years studied, 56,803 patients were admitted with liver disease and 126 underwent Liver transplantati on (LT). The rate of LT increased from 0.07% to 0.27%. Age, gender, so urce of payment, type of Liver disease, rural county of residence, and distance of residence hom the transplant center were associated with rates of transplantation. in the multivariate model, source of payment appeared to have the strongest association with the likelihood of LT. These findings raise important questions associated with equitable ac cess to health care, need for physician education, and transplant cent er regionalization.