Association of Community Socioeconomic Distress With Waitlist and Survival Outcomes in Liver Transplantation.

IF 5.3 2区医学 Q1 IMMUNOLOGY Transplantation Pub Date : 2025-01-09 DOI:10.1097/TP.0000000000005328

Sara Sakowitz, Syed Shahyan Bakhtiyar, Saad Mallick, Fady Kaldas, Peyman Benharash

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Abstract

Background: Despite efforts to ensure equitable access to liver transplantation (LT), significant disparities remain. Although prior literature has considered the effects of patient sex, race, and income, the contemporary impact of community socioeconomic disadvantage on outcomes after waitlisting for LT remains to be elucidated. We sought to evaluate the association of community-level socioeconomic deprivation with survival after waitlisting for LT.

Methods: All waitlisted candidates for isolated LT were identified using the 2005-2023 Organ Procurement and Transplantation Network. The previously validated Distressed Communities Index, representing poverty rate, median household income, unemployment, business growth, education level, and housing vacancies, was used to characterize community socioeconomic distress. Zip codes in the highest quintile were classified as the "distressed" cohort (others: "nondistressed"). Kaplan-Meier and Cox proportional hazard models were applied to assess patient and graft survival. We performed a Fine and Gray competing risk regression to consider the impact of distress on waitlist mortality.

Results: Of 169 601 patients, 95 020 (56%) underwent LT and 74 581 (44%) remained on the waitlist. Among transplanted patients, 18 774 (20%) were distressed. After adjustment, distressed faced similar posttransplant survival at 1 y but greater mortality hazard at 5 y (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.04-1.12) and 10 y (HR, 1.09; 95% CI, 1.05-1.12). Considering all waitlisted patients, competing risk analysis demonstrated distressed candidates to face significantly greater cumulative incidence of death/deterioration on the waitlist (HR, 1.07; 95% CI, 1.04-1.11).

Conclusions: Community-level socioeconomic inequity is associated with greater waitlist mortality and inferior post-LT survival. Novel interventions are needed to address structural barriers to care and continued inequities in outcomes.

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社区社会经济困境与肝移植等待名单和生存结果的关系。

背景：尽管努力确保公平获得肝移植（LT），但显著的差异仍然存在。虽然先前的文献已经考虑了患者性别、种族和收入的影响，但社区社会经济劣势对LT候补后结果的当代影响仍有待阐明。我们试图评估社区水平的社会经济剥夺与等待移植后生存的关系。方法：使用2005-2023器官获取和移植网络确定所有等待孤立性移植的候选人。先前验证的贫困社区指数，代表贫困率，家庭收入中位数，失业率，商业增长，教育水平和住房空置率，用于表征社区社会经济困境。邮政编码最高的五分之一被归类为“贫困”群体（其他为“非贫困”群体）。Kaplan-Meier和Cox比例风险模型用于评估患者和移植物的存活率。我们进行了Fine和Gray竞争风险回归，以考虑焦虑对等候名单死亡率的影响。结果：在169601例患者中，95020例（56%）接受了肝移植，74581例（44%）仍在等待名单上。移植患者中有18774例（20%）感到痛苦。调整后，患者移植后1年生存率相似，但5年死亡率更高(危险比[HR]， 1.08；95%可信区间[CI]， 1.04-1.12)和10 y (HR, 1.09；95% ci, 1.05-1.12)。考虑到所有等候名单患者，竞争风险分析表明，在等候名单上，痛苦的候选人面临更大的累积死亡/恶化发生率(HR, 1.07；95% ci, 1.04-1.11)。结论：社区层面的社会经济不平等与更高的等待名单死亡率和较低的肝移植后生存率有关。需要新的干预措施来解决护理的结构性障碍和持续的不平等结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.