Examining racial and socioeconomic disparity in the pediatric heart transplant evaluation

Carlo, Waldemar F.; Floyd, Samantha; Pearce, F. Bennett; Collins, J Leslie Gaddis; Hubbard, M.; Dabal, Robert J.; Buckman, Joseph; Padilla, Luz A.; Kirklin, James K.

doi:10.1111/petr.13979

Cited by 9 publications

(13 citation statements)

References 10 publications

(20 reference statements)

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“…Further, higher SES was associated with lower waitlist mortality for White and Hispanic patients, while higher SES was associated with greater waitlist mortality among Black patients 52 . A greater proportion of patients with identified “social concerns” at evaluation beyond SES and financial means were Black, with Black patients also having significantly lower income 47 . Five studies found no association between SES and pre‐transplant outcomes, including no associations with waitlist mortality, 27,28 likelihood of 28 or time to transplant, 49 or transplant knowledge 48 .…”

Section: Resultsmentioning

confidence: 91%

“…However, one US/Canadian study found patients receiving dialysis prior to transplant were less likely to be Black 7 and another in Austria found no differences in rates of preemptive transplantation across ethnicity 19 . Two studies in the US found no differences in rates of referral or likelihood of transplant with regard to race 22,47 . Racial or ethnic identity was not associated with knowledge about living donation, understanding evaluation steps, or knowing insurance coverage 48 …”

Section: Resultsmentioning

confidence: 98%

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A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

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Background: Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre-and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods. Methods: Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases. Results: Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent. Conclusion: This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities. K E Y W O R D S social determinants of health, disparity, pediatric organ transplantation 2 of 33 | REA et al. 1 | INTRODUC TI ON Equitable access to organ transplantation and subsequent transplantrelated medical care is a critical goal across healthcare centers. Over the years, studies have identified risk factors impacting listing status and transplant-related outcomes, with greater scrutiny recently on clinical tools impacting organ allocation, selection, and donation processes. 1 These steps are critical in identifying areas of structural racism which continue to impact Black, Indigenous, and people of color as well as the intersectionality of socioeconomic factors within the patient population as a whole. To summarize findings to date, a systematic review of the available literature was conducted. Studies included assessments of SDoH in the evaluation, listing, and post-transplant periods. The US Department of Health and Human Services identifies five domains of SDoH that include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. 2 Special consideration was given to dynamic interplay between these factors to better understand social processes underlying health outcomes and identify potential intervention areas. | ME THODS | Search strategyThis systematic review is in accordance with PRISMA guidelines.Comprehensive search strategies were created for Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature, including controlled vocabulary terms from each database combined logically with keywords using Boolean Logic. Terms were extracted per the following concepts: pediatrics, organ transplantation, disparities, and identity (see example searc...

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 98%

A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

View full text Add to dashboard Cite

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“…Therefore, this analysis is just one part of our process of introspection as an institution to understand the inequities and lack of access within our own system and work to improve access and referral for these life‐saving therapies. One recent single‐center analysis similarly evaluated 133 patients referred for heart transplant evaluation in children 15 . The authors found that Black patients composed 44% of those referred with more markers of socioeconomic disadvantage; yet, race did not seem to impact listing for transplant 15 .…”

Section: Discussionmentioning

confidence: 99%

“…One recent single‐center analysis similarly evaluated 133 patients referred for heart transplant evaluation in children 15 . The authors found that Black patients composed 44% of those referred with more markers of socioeconomic disadvantage; yet, race did not seem to impact listing for transplant 15 . The authors similarly note the importance of continuing to evaluate upstream racial disparities during the referral and evaluation processes.…”

Section: Discussionmentioning

confidence: 99%

Impact of socioeconomic deprivation on evaluation for heart transplantation at an urban academic medical center

DeFilippis

Clerkin

Givens

et al. 2022

Clinical Transplantation

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Introduction:For patients with advanced heart failure, socioeconomic deprivation may impede referral for heart transplantation (HT). We examined the association of socioeconomic deprivation with listing among patients evaluated at our institution and compared this against the backdrop of our local community. Methods:We conducted a retrospective cohort study of patients evaluated for HT between January 2017 and December 2020. Patient demographics and clinical characteristics were recorded. Block group-level area deprivation index (ADI) decile was obtained at each patient's home address and Socioeconomic Status (SES) index was determined by patient zip code. Results:In total, 400 evaluations were initiated; one international patient was excluded. Among this population, 111 (27.8%) were women, 219 (54.9%) were White, 94 (23.6%) Black, and 59 (14.8%) Hispanic. 248 (62.2%) patients were listed for transplant. Listed patients had significantly higher SES index and lower ADI compared to those who were not listed. However, after adjustment for clinical factors, ADI and SESi were not predictive of listing. Similarly, patient sex, race, and insurance did not influence the likelihood of listing for HT. Notably, the distribution of the referral cohort based on ADI deciles was not reflective of our center's catchment area, indicating opportunities for improving access to transplant for disadvantaged populations.Conclusions: Although socioeconomic deprivation did not predict listing in our analysis, we recognize the need for broader outreach to combat upstream bias that prevents patients from being referred for HT.

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“…There is evidence that health disparities, including race or ethnicity, insurance, income, and other sociodemographic barriers, 6‐10 contribute to delays in listing for organ transplantation in adult populations 10‐14 . Within pediatric transplant, similar disparities have been documented across racial, 5,13,15‐18 socioeconomic, 19 and other demographic factors (e.g., insurance type, gender) 20 . However, little research has compared waiting time between patients requiring various organ types, such as pediatric heart, liver, and kidney transplantation.…”

Section: Introductionmentioning

confidence: 98%

Understanding disparities and barriers associated with pediatric transplant evaluation and time to listing: Moving toward a more comprehensive picture

Christofferson

Ruzicka

Bolt

et al. 2021

Pediatric Transplantation

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Background Delayed time to listing (TTL) for pediatric transplant patients is associated with increased risks of mortality and morbidity. The full range of health disparities, sociodemographic factors, and other barriers associated with delays in listing in the pediatric transplant candidate evaluation process has not been fully examined. Methods Retrospective chart reviews were conducted for 183 kidney, liver, and heart transplant candidates ages 0–18 who were referred for evaluation during 2012–2015. Demographic information and potential barriers (e g., social/medical factors, financial concerns) were gathered from pre‐transplant evaluations and included in a comprehensive model to evaluate mechanisms that explain differences in TTL. Descriptive statistics, logistic regression models, Cox proportional hazards models, and path analysis were used for analyses. Results Candidates included 26.8% heart, 33.3% liver, and 39.9% kidney patients. The most common barrier to listing was financial (71.6%), followed by caregiver psychological or substance use (57.9%), and medical problems (49.7%). Higher age, kidney, and liver organ type (relative to the heart), and presence of social, medical, administrative/motivation, and financial barriers were all directly associated with longer TTL. Public insurance was indirectly associated with TTL through social, administrative/motivation, and financial barriers. Organ type was indirectly associated with TTL through financial barriers. Conclusions Results suggest social problems, administrative issues, and financial issues act as mechanisms through which insurance type and liver transplant candidates face increased risk of delays in transplant listing time. There are numerous clinical implications and interventions that are warranted to reduce TTL among pediatric transplant candidates with co‐occurring barriers.

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Examining racial and socioeconomic disparity in the pediatric heart transplant evaluation

Cited by 9 publications

References 10 publications

A systematic review of social determinants of health in pediatric organ transplant outcomes

A systematic review of social determinants of health in pediatric organ transplant outcomes

Impact of socioeconomic deprivation on evaluation for heart transplantation at an urban academic medical center

Understanding disparities and barriers associated with pediatric transplant evaluation and time to listing: Moving toward a more comprehensive picture

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