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Association of Citizenship Status With Kidney Transplantation in Medicaid Patients
- Source :
- American journal of kidney diseases : the official journal of the National Kidney Foundation, vol 71, iss 2
- Publication Year :
- 2017
-
Abstract
- Background Although individuals classified as nonresident aliens, including undocumented immigrants, are entitled to receive emergency dialysis in the United States regardless of their ability to pay, most states do not provide them with subsidized care for maintenance dialysis or kidney transplantation. We explored whether nonresident aliens have similar outcomes to US citizens after receiving kidney transplants covered by Medicaid, a joint federal and state health insurance program. Study Design Retrospective observational cohort study. Setting & Participants All adult Medicaid patients in the US Renal Data System who received their first kidney transplant from 1990 to 2011. Predictor Citizenship status, categorized as US citizen, nonresident alien, or permanent resident. Outcome All-cause transplant loss. Measurements HRs and 95% CIs estimated by applying Cox proportional hazards frailty models with transplantation center as a random effect. Results Of 10,495 patients, 8,660 (82%) were US citizens, 1,489 (14%) were permanent residents, and 346 (3%) were nonresident aliens, whom we assumed were undocumented immigrants. Nonresident aliens were younger, healthier, receiving dialysis longer, and more likely to have had a living donor. 71% underwent transplantation in California, and 61% underwent transplantation after 2005. Nonresident aliens had a lower unadjusted risk for transplant loss compared with US citizens (HR, 0.48; 95% CI, 0.35-0.65). Results were attenuated but still significant when adjusted for demographics, comorbid conditions, dialysis, and transplant-related factors (HR, 0.67; 95% CI, 0.46-0.94). Limitations Citizenship status was self-reported, possible residual confounding. Conclusions Our study suggests that the select group of insured nonresident aliens who undergo transplantation with Medicaid do just as well as US citizens with Medicaid. Policymakers should consider expanding coverage for kidney transplantation in nonresident aliens, including undocumented immigrants, given the associated high-quality outcomes in these patients.
- Subjects :
- Gerontology
Male
citizenship
Kidney Disease
medicine.medical_treatment
Immigration
030232 urology & nephrology
Kidney Failure
Cohort Studies
Kidney transplantation
0302 clinical medicine
Medicine
030212 general & internal medicine
Chronic
media_common
end-stage renal disease
Confounding
Undocumented Immigrants
Middle Aged
Urology & Nephrology
Treatment Outcome
Nephrology
Public Health and Health Services
Female
US health care policy
Cohort study
immigration
Adult
Waiting Lists
media_common.quotation_subject
undocumented immigrants
Clinical Trials and Supportive Activities
Clinical Sciences
Renal and urogenital
Emigrants and Immigrants
Article
03 medical and health sciences
Clinical Research
Renal Dialysis
Humans
Dialysis
Retrospective Studies
Transplantation
business.industry
Proportional hazards model
non-resident aliens
Medicaid
Prevention
transplant outcomes
Organ Transplantation
medicine.disease
Kidney Transplantation
United States
Kidney Failure, Chronic
business
Demography
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation, vol 71, iss 2
- Accession number :
- edsair.doi.dedup.....c13b1f807eda993e9db29136ec77290a