Rates of solid-organ wait-listing, transplantation, and survival among residents of rural and urban areas

Abstract

Context: Disparities in access to organ transplantation exist for racial minorities, women, and patients with lower socioeconomic status or inadequate insurance. Rural residents represent another group that may have impaired access to transplant services. Objective: To assess the association of rural residence with waiting list registration for heart, liver, and kidney transplant and rates of transplantation among wait-listed candidates. Design, Setting, and Patients: Five-year US cohort of 174 630 patients who were wait-listed and who underwent heart, liver, or kidney transplantation between 1999 and 2004. Main Outcome Measures: Rates of new waiting list registrations and transplants per million population for residents of 3 residential classifications (rural/small town population, <10 000; micropolitan, 10 000-50 000; and metropolitan >50 000 or suburb of major city). Results: Compared with urban residents, waiting list registration rates for rural/small town residents were significantly lower for heart (covariate-adjusted rate ratio [RR]=0.91; 95% confidence interval [CI], 0.86-0.96; P