Background Socioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation (KTX). The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of studies analyzing this measure longitudinally or between races. Methods Longitudinal cohort study in adult KTX transplanted at a single-center between 2005 and 2012. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a minimum of 0 and maximum of 3 for an aggregate of 0 to 15 (higher score → better SES). Results 1,171 patients were included; 624 (53%) were African American (AA) and 547 were non-AA. AAs had significantly lower mean baseline SAI scores (AAs 6.5, vs. non-AAs 7.8; p<0.001). Cox regression analysis demonstrated that there was no association between baseline SAI and acute rejection in non-AAs (HR 0.92, 95% CI 0.81–1.05), while it was a significant predictor of acute rejection in AAs (HR 0.89, 95% CI 0.80–0.99). Similarly, A two stage approach to joint modelling of time to graft loss and longitudinal SAI did not predict graft loss in non-AAs (HR 1.01, 95% 0.28–3.62), while it was a significant predictor of graft loss in AAs (HR 0.23, 95% 0.06–0.93). Conclusion After controlling for confounders, SAI scores were associated with a lower risk of acute rejection and graft loss in AA kidney transplant recipients; while neither baseline nor follow up SAI predicted outcomes in non-AA kidney transplant recipients.
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