Mo932population Density and U.S. Kidney Transplantation During the First Year Covid-19 Pandemic

Abstract

Background and Aims Coronavirus disease 19 (COVID-19) pandemic leads to poorer health outcomes and more utilizing of healthcare resources. Kidney transplant (KT) can lead to worsening transplant outcomes with COVID-19 and trend of KT in the United States decreases. Given a highly contagious disease, high population density may contribute to not only higher rate of the disease, but also lower rate of KT. We aim to examine the association of the number of COVID-19 cases and change in the number of KT with the interaction of population density in the United States. Method A cross-sectional study was conducted by using publicly available data of COVID-19 cases and KT in the United States were retrieved from the Centers of Disease Control and Prevention (CDC) and the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR), respectively. The association of the cumulative COVID-19 cases of 47 states in the United States where KT occurred between January 1, 20202 and January 6, 2021 with difference in the number of KT between year 2019 and 2020 (ΔKT) was examined by using multiple linear regression. Results During the study period, a total of 20,136,895 COVID-19 cases were detected in the United States and 326,535 patients died. From all 47 states, 23,002 and 20,554 adult KT were performed in 2019 and 2020, respectively. Mean COVID-19 cases and deaths were 428,445±457,344 and 6,948± 6,911, respectively among the 47 states. Mean ΔKT2019 - 2020 were 52± 81. Every 10,000 COVID-19 cases was associated with a decrease in 1.06 KT in year 2020 compared to year 2019 (βcoeff 0.00011, p <0.0001, 95% CI 0.00006, 0.00015). However, after adjusted for the number of KT in 2019, COVID-19 cases (< or ≥ median cases of 317,545), population density (< or ≥ median density of 114 people/mile2), and the interaction term between COVID-19 cases and population density, the states with high rate of COVID-19 (≥317,545 cases/year) and high population density (≥114 people/mile2) had a decrease in 12.4 KT; whereas, there was 4.5 KT decrease in states with low COVID-19 rate and low population density (βcoeff 0.1024705, p 0.000, 95%CI 0.066272, 0.1386691, p interaction -0.686). Conclusion The number of KT in 2020 has decreased independent to the number of 2019 KT and population density. However, a decrease in the number of KT was lower in the states with low COVID-19 rate and low population density compared to those with high COVID-19 rate and high population density. Distribution of healthcare resources and utilization including KT in the states with low COVID-19 cases and low population density may be one of the strategies to continue KT, which is life-saving therapy and better survival benefit compared to being on dialysis in end-stage kidney disease population with a high mortality risk.