Socioeconomic Inequities in Preemptive Kidney Transplantation and Graft Survival: An Innovative Approach to Identifying Disparities in Kidney Transplantation
Background. The limitations of conventional measures of socioeconomic status (SES) limit our ability to elucidate the role of SES as a key element of social determinants of health in kidney transplantation. This study’s objective was to use an innovative SES measure, the HOUsing-based SES measure (H...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-01-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001734 |
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| author | Sarah Kizilbash, MD Chung-II Wi, MD Madison Roy, MS Euijung Ryu, PhD Arthur Matas, MD Vesna Garovic, MD, PhD Samy Riad, MD, MS Carrie Schinstock, MD Young Juhn, MD |
| author_facet | Sarah Kizilbash, MD Chung-II Wi, MD Madison Roy, MS Euijung Ryu, PhD Arthur Matas, MD Vesna Garovic, MD, PhD Samy Riad, MD, MS Carrie Schinstock, MD Young Juhn, MD |
| author_sort | Sarah Kizilbash, MD |
| collection | DOAJ |
| description | Background. The limitations of conventional measures of socioeconomic status (SES) limit our ability to elucidate the role of SES as a key element of social determinants of health in kidney transplantation. This study’s objective was to use an innovative SES measure, the HOUsing-based SES measure (HOUSES) index, to examine the effects of social determinants of health on access to and outcomes of kidney transplantation.
Methods. Our study included residents of Minnesota (age older than 18 y) who underwent kidney transplantation at a single center between 2010 and 2020. SES was determined using the HOUSES index, categorized into quartiles (Q1 for lower, Q2–Q4 for higher SES). We used mixed-effects multivariable logistic and Cox models to examine the effects of HOUSES on preemptive transplants, pretransplant dialysis duration, and death-censored graft loss, adjusting for covariates.
Results. Among 1975 eligible patients, 29.4% received preemptive transplants, 34.9% underwent pretransplant dialysis for >3 y, and 15.1% experienced death-censored graft loss for a median follow-up of 7.15 (interquartile range, 4.25–11.38) y. Lower SES recipients (Q1) demonstrated decreased preemptive transplant likelihood (adjusted odds ratio [aOR]: 0.74; 95% confidence interval [CI], 0.57-0.97; P = 0.03), longer dialysis duration (>3 y; aOR: 1.43; 95% CI, 1.01-2.03; P = 0.046), and higher death-censored graft loss (adjusted hazard ratio 1.36; 95% CI, 1.02-1.12; P = 0.036) versus higher SES recipients (Q2–Q4).
Conclusions. We observed significant socioeconomic disparities in kidney transplant access, dialysis duration, and graft survival. The HOUSES index may be a promising tool for individual-based targeted interventions as it identifies SES on an individual rather than an area-level basis. |
| format | Article |
| id | doaj-art-12fb962a42284195a1e2c44ee4e01d6b |
| institution | Kabale University |
| issn | 2373-8731 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer |
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| series | Transplantation Direct |
| spelling | doaj-art-12fb962a42284195a1e2c44ee4e01d6b2024-12-24T09:47:18ZengWolters KluwerTransplantation Direct2373-87312025-01-01111e173410.1097/TXD.0000000000001734202501000-00007Socioeconomic Inequities in Preemptive Kidney Transplantation and Graft Survival: An Innovative Approach to Identifying Disparities in Kidney TransplantationSarah Kizilbash, MD0Chung-II Wi, MD1Madison Roy, MS2Euijung Ryu, PhD3Arthur Matas, MD4Vesna Garovic, MD, PhD5Samy Riad, MD, MS6Carrie Schinstock, MD7Young Juhn, MD81 Department of Pediatrics, University of Minnesota, Minneapolis, MN.2 Precision Population Science Lab, Department of Pediatric and Adolescent Medicine Mayo Clinic, Rochester, MN.3 Precision Population Science Lab, Department of Quantitative Health Science, Mayo Clinic, Rochester, MN.3 Precision Population Science Lab, Department of Quantitative Health Science, Mayo Clinic, Rochester, MN.4 Department of Surgery, University of Minnesota, Minneapolis, MN.5 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.5 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.5 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.6 Precision Population Science Lab, Department of Pediatric and Adolescent Medicine/Internal Medicine, Mayo Clinic Rochester and Mayo Clinic Health System, MN.Background. The limitations of conventional measures of socioeconomic status (SES) limit our ability to elucidate the role of SES as a key element of social determinants of health in kidney transplantation. This study’s objective was to use an innovative SES measure, the HOUsing-based SES measure (HOUSES) index, to examine the effects of social determinants of health on access to and outcomes of kidney transplantation. Methods. Our study included residents of Minnesota (age older than 18 y) who underwent kidney transplantation at a single center between 2010 and 2020. SES was determined using the HOUSES index, categorized into quartiles (Q1 for lower, Q2–Q4 for higher SES). We used mixed-effects multivariable logistic and Cox models to examine the effects of HOUSES on preemptive transplants, pretransplant dialysis duration, and death-censored graft loss, adjusting for covariates. Results. Among 1975 eligible patients, 29.4% received preemptive transplants, 34.9% underwent pretransplant dialysis for >3 y, and 15.1% experienced death-censored graft loss for a median follow-up of 7.15 (interquartile range, 4.25–11.38) y. Lower SES recipients (Q1) demonstrated decreased preemptive transplant likelihood (adjusted odds ratio [aOR]: 0.74; 95% confidence interval [CI], 0.57-0.97; P = 0.03), longer dialysis duration (>3 y; aOR: 1.43; 95% CI, 1.01-2.03; P = 0.046), and higher death-censored graft loss (adjusted hazard ratio 1.36; 95% CI, 1.02-1.12; P = 0.036) versus higher SES recipients (Q2–Q4). Conclusions. We observed significant socioeconomic disparities in kidney transplant access, dialysis duration, and graft survival. The HOUSES index may be a promising tool for individual-based targeted interventions as it identifies SES on an individual rather than an area-level basis.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001734 |
| spellingShingle | Sarah Kizilbash, MD Chung-II Wi, MD Madison Roy, MS Euijung Ryu, PhD Arthur Matas, MD Vesna Garovic, MD, PhD Samy Riad, MD, MS Carrie Schinstock, MD Young Juhn, MD Socioeconomic Inequities in Preemptive Kidney Transplantation and Graft Survival: An Innovative Approach to Identifying Disparities in Kidney Transplantation Transplantation Direct |
| title | Socioeconomic Inequities in Preemptive Kidney Transplantation and Graft Survival: An Innovative Approach to Identifying Disparities in Kidney Transplantation |
| title_full | Socioeconomic Inequities in Preemptive Kidney Transplantation and Graft Survival: An Innovative Approach to Identifying Disparities in Kidney Transplantation |
| title_fullStr | Socioeconomic Inequities in Preemptive Kidney Transplantation and Graft Survival: An Innovative Approach to Identifying Disparities in Kidney Transplantation |
| title_full_unstemmed | Socioeconomic Inequities in Preemptive Kidney Transplantation and Graft Survival: An Innovative Approach to Identifying Disparities in Kidney Transplantation |
| title_short | Socioeconomic Inequities in Preemptive Kidney Transplantation and Graft Survival: An Innovative Approach to Identifying Disparities in Kidney Transplantation |
| title_sort | socioeconomic inequities in preemptive kidney transplantation and graft survival an innovative approach to identifying disparities in kidney transplantation |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001734 |
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