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Distance from liver transplant centers linked to increased mortality in veterans
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Veterans who lived farther away from a Veterans Affairs Transplant Center or any center decreased their chances of waitlist placement, liver transplantation and survival, according to recent study results.
“Our study is the first to show that while the VA model of centralized health care might serve to control costs … it actually has negative consequences for many veterans,” researcher David S. Goldberg, MD, MSCE, instructor of medicine, Perelman School of Medicine at the University of Pennsylvania, said in a press release.
David S. Goldberg
Goldberg and colleagues found that veterans with liver disease who lived more than 100 miles from the five Veterans Affairs transplant centers were not as likely to be placed on a liver transplantation waitlist compared with veterans who lived closer.
Of 50,637 veterans eligible for transplant between 2003 and 2010, 2,895 (6%) were waitlisted, including 1,418 patients who were waitlisted at a VATC. Data showed that 3,417 veterans received care at a VA hospital within 100 miles of a VATC, with 244 patients (7.1%) waitlisted at a VATC and 372 (10.9%) waitlisted at any transplant center.
Among 47,219 veterans receiving care greater than 100 miles from a VATC, 1,174 (2.5%) were waitlisted at a VATC and 2,523 (5.3%) at any transplant center.
Using multivariable analysis, when distance from a VATC was increased, veterans had lower odds of being waitlisted at a VATC (OR=0.91; 95% CI, 0.89-0.93 for each doubling distance) or any transplant center (OR=0.94; 95% CI, 0.92-0.96 for each doubling distance). In multivariable subhazard ratio analysis, each doubled distance to a VATC also produced lower transplantation rates (HR=0.97; 95% CI, 0.95-0.98).
After a patient experienced an initial hepatic decompensation event, increased distance from a local VA hospital to a VATC was associated with increased mortality risk (HR=1.03; 95% CI, 1.01-1.04).
“Greater distance from a VATC or any transplant center was associated with lower likelihood of being put on a waitlist or receiving a transplant, and greater likelihood of death,” the researchers wrote. “The relationship between these findings and centralizing specialized care deserves further investigation.”
Disclosure: The researchers report no relevant financial disclosures.