Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients

Abstract

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.

Big Data, Predictive Analytics, and Quality Improvement in Kidney Transplantation: A Proof of Concept

“…Our approach identified this association and its contribution to the force of mortality in a direction consistent with prior experiences. Additionally, the results underscore the importance of social support and a greater degree of educational attainment as being protective for GL, which is consistent with our prior observations .…”

A Comparative Effectiveness Analysis of Early Steroid Withdrawal in Black Kidney Transplant Recipients

“…Blacks are considered such a group, because the literature has clearly shown that they have a number of important factors that increase immunologic risks (10). These include lower rates of living donors, socioeconomic disadvantages, greater HLA mismatches, higher capacity to metabolize immunosuppressant medications, and polymorphisms that increase immunoreactivity (10)(11)(12)(13). Additionally, the aforementioned RCTs that assessed ESW safety contained disproportionately low numbers of blacks (8,9).…”

“…Hazard ratios for the risk of graft loss and death in early steroid withdrawal versus continued steroid (reference) stratified by modifying variables and time periods .83 to 0.97) 1 12. (1.02 to 1.24) 0.92 (0.86 to 0.99) 1.20 (1.05 to 1.36) 0.93 (0.86 to 0.99) 1.15 (1.01 to 1.30) 1.19 (1.06 to 1.33) 0.91 (0.85 to 0.98) .71 to 0.89) 1.11 (0.97 to 1.26) 0.83 (0.76 to 0.92) 1.22 (1.03 to 1.44) 0.81 (0.73 to 0.89) 1.26 (1.06 to 1.48) 1.05 (0.91 to 1.22) 0.86 (0.78 to 0.95) MMF, mycophenolate mofetil; MPA, mycophenolic acid; 95% CI, 95% confidence interval.…”

Outcome disparities between African Americans and Caucasians in contemporary kidney transplant recipients

“…These include risk factors for graft loss, such as medication nonadherence, changes in socioeconomics and/or health insurance and clinical events (cardiovascular disease and cancer). 12,13,23,38 It is likely that these are strong mediating factors that influence AA disparities. Thus, this analysis does not provide a fully comprehensive assessment of the predominant causes of racial disparities in transplant.…”