Disparities in Access to Heart and Lung Transplantation by Race and Socioeconomic Status: A National Analysis

Disparities in heart and lung transplantation persist in the United States, yet most studies focus only on patients already referred or listed. We aimed to evaluate racial and socioeconomic disparities in access and receipt of transplantation among patients with chronic heart or lung disease. We conducted a retrospective analysis using the National Inpatient Sample (2016–2022) to identify adults hospitalized with chronic heart or lung disease. Patients undergoing heart or lung transplantation and combine heart and lung transplantation were identified via ICD-10 codes. Multivariable logistic regression assessed associations between transplant receipt and race/ethnicity and ZIP-code–level income, after adjustment for age, sex, insurance status, comorbidities, and diagnosis. Among 5.1 million chronic lung and 2.1 million chronic heart disease hospitalizations, 4776 lung, 1537 heart transplants and 76 combined heart and lung transplants were identified. White patients had significantly higher odds of receiving lung transplantation (aOR: 3.97; 95% CI, 1.72–9.13, p < .01) than Black, Hispanic and Native American patients while in heart transplantation, Black patients had higher odds of getting transplanted (aOR: 3.09; 95% CI, 1.17–8.17, p = .02) than White, Hispanic and Native American patients. Patients from the highest-income ZIP codes were more likely to undergo lung (aOR: 3.63; 95% CI, 3.24–4.05, p < .01) or heart (aOR: 1.33; 95% CI, 1.13–1.55, p < .01) transplantation. No significant disparities were observed in combine heart and lung transplant patients. Significant disparities by race and socioeconomic status persist in transplant access both in lung and heart transplantation. These findings highlight upstream structural barriers and offer a pre–Composite Allocation Score (CAS) baseline for future policy evaluation.