The Impact of Medicare's lifetime immunosuppression coverage on racial disparities in kidney graft survival.

Beginning January 1, 2000, Medicare effectively extended its coverage of immunosuppression medications from 3 years to lifetime for patients eligible for Medicare on the basis of age or disability status. We examined the impact of this policy on racial disparities in kidney transplant outcomes at 5 years. Using data from the US Renal Data System, we identified cohorts of Medicare-insured kidney transplant recipients according to patient characteristics defining eligibility for lifetime immunosuppression coverage according to the year 2000 policy. We compared racial disparities in graft survival among those eligible for lifetime coverage with the Kaplan-Meier method. We modeled adjusted associations of patient race, patient income, benefits eligibility category and policy exposure with graft loss by multivariable Cox's regression. The racial disparity in graft survival between African American and non-African American among transplant recipients eligible for the lifetime benefit persisted. The graft survival disparity between high- and low-income African American recipients was insignificantly reduced among those eligible for the lifetime benefit. The results of the study suggest that insurance coverage of medication did not eliminate or reduce the racial disparity in graft survival.

Income-related disparities in kidney transplant graft failures are eliminated by Medicare's immunosuppression coverage.

Beginning January 1, 2000, Medicare extended coverage of immunosuppression medications from 3 years to lifetime based on age >65 years or disability. Using United States Renal Data System (USRDS) data for Medicare-insured recipients of kidney transplants between July 1995 and December 2000, we identified four cohorts of Medicare-insured kidney transplant recipients. Patients in cohort 1 were individuals who were both eligible and received lifetime coverage. Patients in cohort 2 would have been eligible, but their 3-year coverage expired before lifetime coverage was available. Patients in cohort 3 were ineligible for lifetime coverage because of youth or lack of disability. Patients in cohort 4 were transplanted between 1995 and 1996 and were ineligible for lifetime coverage. Incomes were categorized by ZIP code median household income from census data. Lifetime extension of Medicare immunosuppression was associated with improved allograft survival among low-income transplant recipients in the sense that the previously existing income-related disparities in graft survival in cohort 2 were not apparent in cohort 1. Ineligible individuals served as a control group; the income-related disparities in graft survival observed in the early cohort 4 persisted in more recent cohort 3. Multivariate proportional hazards models confirmed these findings. Future work should evaluate the cost effectiveness of these coverage increases, as well as that of benefits extensions to broader patient groups.

Metabolite of (-)-trans-delta 8-tetrahydrocannabinol: identification and synthesis.

The major metabolite of (-)-trans-Delta(8)-tetrahydrocannabinol observed in vivo and formed by hepatic microsomes in vitro is 11-hydroxy-trans-Delta(8)-tetrahydrocannabinol. The metabolite was identified spectroscopically and was synthesized from trans-Delta(8)-tetrahydrocannabinol. In tests with rats, the metabolite produced behavioral effects similar to those imparted by Delta(8)- and Delta(9)-tetrahydrocannabinol.

Polywater: proton nuclear magnetic resonance spectrum.

In the presence of water, the resonance of the strongly hydrogenbonded protons characteristic of polywater appears at 5 parts per million lower applied magnetic field than water. Polywater made by a new method confirms the infrared spectrum reported originally.