Background: Native Americans have been shown to face decreased access to waitlisting and transplantation.They appear to have similar short-term survival prospects post-transplant to those of whites, but lower longer term survival. After documenting the disparities in post-transplant care, we explore the possibility that Native Americans might face decreased access to high quality post-transplant care, especially in the long-run, due to a decreased general access to healthcare, as is faced by many socioeconomically disadvantaged minority populations.

Methods: Using data from the Organ Procurement and Transplantation Network, we evaluated the quantity and type of post-transplant care received by Native Americans. We compare Native American populations with other ethnic groups from October 1, 1987 to December 31, 2012 using multivariate regression analysis, controlling for time-invariant factors affecting all patients in a given year (year fixed effects) and time-varying factors associated with a specific transplant center (center fixed effects). (Standard errors are clustered at the center level to account for heteroskedasticity and spatial correlation among patients in a given center.)

Results: Statistically significant regression results (p<0.05) indicate that Native Americans are less likely to receive transplant program-based aftercare than other racial/ethnic groups (Black, White, Hispanic and Asian/Pacific Islander), opting instead to see other types of specialists. They also are two percentage points more likely to be lost to follow-up (mean=0.15), one percentage point less likely to participate in an immunosuppression-related research study (mean=0.03), and receive 0.3 fewer follow-up visits (mean=2.2) than whites. Relative to other races and ethnicities, they face the lowest number of follow-up visits, the lowest probability of participating in a research study, and the highest probability of being lost to follow-up. They are also thirteen percentage points less likely to work post-transplant (mean=0.35) than whites.

Conclusions: The results indicate that Native Americans have reduced access to high quality post-transplant care. Further research will explore how much of the disparity in post-transplant care is related to the high correlation between being Native American and poor and between being Native American and living in a rural area, especially on tribal lands.

« Back to 2015 American Transplant Congress