High local unemployment rates limit work after lung transplantation

Abstract

LTx recipients of working age exhibit exceptionally low employment rates. High local unemployment rates exacerbate low work participation after LTx, and may discourage job search in this population.

Employment after heart transplantation among adults with congenital heart disease

“…In the present study, 27% of adults with CHD undergoing HTx were employed at some point after transplant, with a mean follow‐up duration of 5 y. This proportion is similar to data recently reported for US adults of working age receiving HTx for any indication in 2010–2014 but is lower than the 3‐y post‐HTx employment rate (46%) for adults ages 25–60 reported in the International Society for Heart and Lung Transplantation Registry . In single‐center studies conducted in countries with single‐payer health insurance, rates of employment after HTx have ranged from 25% to 69%, although these estimates are limited by small samples and inconsistent durations of follow‐up .…”

“…Patients receiving multiorgan transplants and patients with no follow‐up data on employment status were excluded. Transplant centers were required to report recipients' employment status (i.e., whether or not patients were working for income) at each transplant anniversary, up to 5 y posttransplant, as previously described . The primary outcome in the study was working for income at any point during post‐HTx follow‐up.…”

“…Among adults with CHD, heart transplantation (HTx) is a treatment option for end‐stage heart failure after previous surgical intervention, or for CHD manifesting in later life . HTx potentially allows transplant recipients to return to their usual activities, but the costs of transplantation and lifelong follow‐up in the United States (US) create the risk of a “transplant trap,” such that transplant recipients may forego paid work to retain eligibility for public health insurance . Prior studies of adults with CHD have demonstrated low rates of work participation relative to the general population, particularly among adults with severe disease; yet it remains unknown to what extent adults with CHD successfully pursue paid work if they undergo HTx.…”

County socioeconomic characteristics and heart transplant outcomes in the United States

“…There are too few heart transplant recipients in small geographic units (eg, ZIP codes) to formally test whether transplant outcomes exhibit clustering at this geographical level. 16 Whereas prior studies have evaluated specific geographical predictors of heart transplant outcomes, these studies did not provide a test for residual geographic variation in patient outcomes (not attributable to the explicitly measured ecological factor). 7,32 Therefore, we examined shared frailty of heart transplant recipients at the county level.…”

“…Patients’ residence was defined using ZIP codes, but there were too few patients in each ZIP code to evaluate clustering of transplant outcomes at that geographic level. 16 Therefore, ZIP codes were linked to US counties according to the county that contained the majority of each ZIP code’s population. Patients were excluded from the analysis if they were missing data on ZIP code of residence and if they were missing data on local socioeconomic measures, described below.…”