Residents of U.S. rural areas are up to 20 percent less likely to get a heart, kidney or liver transplant than urban dwellers, researchers reported on Tuesday.
The reason is likely to be distance from specialists and screening operations that are concentrated in urban areas, though investigators said lack of insurance coverage and poverty could be factors.
"When you look at our study it suggests that the barrier to transplantation is not from within the transplant centers but it's really the barriers to getting in the front door in the first place," said Dr. David Axelrod of the Dartmouth Medical School, in Lebanon, New Hampshire, who led the research.
"We need to consider, is it reasonable for someone to drive eight or 10 hours on a regular basis just to have health care?" he added.
The report published in this week's Journal of the American Medical Association was based on an analysis, based on ZIP codes, of 174,630 patients who were wait-listed for or underwent heart, liver, or kidney transplants from 1999 to 2004.
Overall, rural patients were 10 percent to 20 percent less likely to undergo transplants than patients in urban areas, the study found.
Rural residents were also 8 percent to 15 percent less likely to get on a waiting list for a transplant, something that requires evaluation, referral and other steps; but once they cleared that hurdle, rural residents got liver and kidney transplants at the same rate as urban dwellers, though they tended to have to wait longer for heart transplants.
The researchers said 14 percent of the U.S. population lives outside of major urban areas, and those who do often face hurdles when it comes to health care in general, including distance from facilities, a lack of local specialists and difficulty in getting follow-up care.
Previous studies found that other groups, including racial minorities, women, the poor and those with inferior health insurance are also likely to face significant barriers when it comes to transplant services.