Role of Socioeconomic Status in Kidney Transplant Outcome

Abstract

There is controversy regarding the influence of genetic versus environmental factors on kidney transplant outcome in minority groups. The goal of this project was to evaluate the role of certain socioeconomic factors in allograft and recipient survival. Graft and recipient survival data from the United States Renal Data System were analyzed using Cox modeling with primary variables of interest, including recipient education level, citizenship, and primary source of pay for medical service. College (hazard ratio [HR] 0.93, P < 0.005) and postcollege education (HR 0.85, P < 0.005) improved graft outcome in the whole group and in patients of white race. Similar trends were observed for recipient survival (HR 0.9, P < 0.005 for college; HR 0.88, P ‫؍‬ 0.09 for postcollege education) in the whole population and in white patients. Resident aliens had a significantly better graft outcome in the entire patient population (HR 0.81, P < 0.001) and in white patients in subgroup analysis (HR 0.823, P < 0.001) compared with US citizens. A similar effect was observed for recipient survival. Using Medicare as a reference group, there is a statistically significant benefit to graft survival from having private insurance in the whole group (HR 0.87, P < 0.001) and in the black (HR 0.8, P < 0.001) and the white (HR 0.89, P < 0.001) subgroups; a similar effect of private insurance is observed on recipient survival in the entire group of patients and across racial groups. Recipients with higher education level, resident aliens, and patients with private insurance have an advantage in the graft and recipient outcomes independent of racial differences.

The Interplay of Socioeconomic Status, Distance to Center, and Interdonor Service Area Travel on Kidney Transplant Access and Outcomes

“…The role of socioeconomic status (SES) in determining access to transplantation services is complex because SES affects care throughout the transplant process (8,9). Patients with low SES often delay seeking medical care and lack access to specialty services, leading to delays in transplant referral, evaluation, and listing (10,11).…”

Religiosity associated with prolonged survival in liver transplant recipients

“…In the United States, educational level has been shown to be a determinant of access to and outcome after kidney transplantation. 32,33 However, these disparities in access to transplant do not apply to our population, in which all the studied patients were already under evaluation for liver transplantation at the same center. Taking into account the data for 14,814 recipients of liver transplants from 1987 to 2001 in the United Network for Organ Sharing database, researchers found that education had only a marginal influence on the outcome; survival was lower in those with only a highschool education versus those who had graduated from college.…”

The role of disparities and socioeconomic factors in access to kidney transplantation and its outcome

“…These characteristics are distributed unequally in the racial groups 28 and they found to be associated with the clinical outcome (e.g. employment status, 29 health insurance type, 30 education level, 30 marital status, 31 substance abuse 32 ), may affect the outcome of kidney transplantation.…”

“…30 Similar to the access to transplantation, the degree of disparities in graft and recipient survival between African Americans and whites gradually decreased with increasing level of education.…”

“…Indeed, the confounding effect of education makes sense as it is unequally distributed in races, 28 and it has an association with transplant outcome 30 and access to transplantation. 33 These alleviating effects of education could be explained in a number of ways.…”