Data shows young, Black adults twice as likely to die after heart transplant

die after heart transplant, medicaid
© Marcos Calvo Mesa

The American Heart Association found that young, Black adults are more than twice as likely to die in the first year after a heart transplant – in comparison to non-Black transplant recipients of the same age

While COVID-19 has been impacting ethnic minorities more harshly than the white population, a further inequality has been unearthed by recent work by the American Heart Association.

When it comes to heart transplants, it seems that young, Black adults are over twice as likely to die in the first year. This is in comparison to non-Black individuals of the same age, not just the white population.

“Our study is the first to highlight young, Black recipients as a subgroup at a higher risk of death during the first year after a heart transplant,” said Hasina Maredia, M.D., first author of the study whose interest in health disparities inspired her to initiate and lead the project as a medical student at Johns Hopkins.

“Our findings indicate clinical research moving forward should focus attention on young, Black recipients during this high-risk period so that longstanding racial disparities seen in heart transplant survival can be improved.”

Almost 23,000 adults examined in this study

Researchers investigated the outcomes of almost 23,000 adults (median age 56, 25% female) who had a heart transplant between 1 January, 2005 and 31 January, 2017. Patient information was obtained from the Scientific Registry of Transplant Recipients.

Risks of mortality were compared between Black and non-Black transplant recipients in four different age groups (18-30 years, 31-40 years, 41-60 years and 61-80 years).

What are the key differences in outcome for Black heart patients?

Black patients are more likely to have diabetes or high blood pressure, a weakened heart muscle and be on Medicaid – as opposed to private insurance. Financial limitations could be driving the lack of access to healthcare post-operation, which means that crucial medications that would prevent organ rejection may not be taken on time or at all.

There was a 30% higher risk of death for Black heart transplant patients, with this risk far higher for the 18-30 age group. The risk remains high, at 1.5 times more likely to die, for the 31-40 age group.

The risk of dying was strongest in the first year after the new heart, giving young, Black patients a 2.3 times higher risk of death in this period of time.

Access to care may be ‘unfairly limited in younger patients’

“Generally, older patients are at a higher risk of having worse outcomes following a major procedure,” said Errol L Bush, MD, senior author of the study, associate professor of surgery and surgical director of the Advanced Lung Disease and Lung Transplant Program at Johns Hopkins University in Baltimore, Maryland. Medicaid expansion was found to improve low-income mortality in pregnancy, by a separate team of researchers. Might there be a similar policy intervention available?

“Organ transplantation, however, is a complex operation that requires lifelong, specialized medical and surgical care. Continued access to the health care system and financial resources such as insurance may be unfairly limited in younger patients, potentially leading to worse outcomes.”

Both researchers further highlighted structural racism in the existing situation: “The high risk associated with Black race is not specifically due to race itself; it is a marker of systemic racism and inequities that have resulted in significant health care disparities.”

Read the full study here.


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