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

Abstract

Background: Research focused on identifying vulnerable populations and revealing specific risk factors for barriers along the pathway from ESRD to kidney transplantation has been mostly descriptive and the causes of existing disparities remain unclear. However, several socio-economic factors that are associated with the access to and the outcome of the kidney transplantation have been identified. Summary: While the presence of racial, gender, and geographic disparities is noted, we were interested mostly to describe potential socioeconomic factors associated with and possibly responsible for the presence of such disparities. In this review we focused on five factors: education level, employment status, income, presence of substance addiction or abuse, and marital status. We describe the new method to quantify patients' socio-economic status and identify the group of high risk in terms of the transplant outcome, easily calculated social adaptability index, previously associated with clinical outcome in several patient populations including those with kidney transplant. At the end, based on literature analyzed we offer potential interventions that potentially can be used in order to reduce the degree of disparities. Conclusion: Based on review of literature socio-economic factors are associated with and possibly responsible for healthcare disparities. Social adaptability index allows quantifying the degree of socio-economic status and identifying the group of high risk for inferior transplant outcome.

Delivery of transplant care among Hmong kidney transplant recipients: Outcomes from a single institution

“…Despite a decades‐long presence in the Twin Cities, the Hmong population remains uniquely vulnerable to healthcare disparities because of their linguistic and cultural isolation, and there is little published data on any immigrant transplant outcomes. With regards to obstacles in ESRD care and the KT evaluation process, a low socioeconomic status, cultural and linguistic isolation, and a general detachment from Western medical care have been partly attributed to inferior outcomes in such vulnerable populations . To date, there are no descriptions on the outcomes after KT in the U.S. Hmong community.…”

Overall Graft Loss Versus Death-Censored Graft Loss

“…Some of these clearly differ across race and have been associated with outcomes in transplantation. 26–28 Medication nonadherence was not accounted for, which may impact racial disparities as well. 29–31 Genetic factors, including gene variants in the donor (APOL1) and recipient (CYP P450 3A5) are more common in NHBs and have been associated with kidney transplant outcomes.…”

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

“…If successful, these interventions may go a long way in reducing the racial disparity that has existed in kidney transplant since its inception. 2,8,11 …”

“…The social adaptability index (SAI) has been developed as a scoring mechanism that quantifies a patient’s SES based on five domains, including education level, employment status, marital status, income level and substance abuse. 11 Research has demonstrated that the SAI is a major risk determinant for health outcomes for diabetes, 12 CKD, 13 ESRD 14 and access to transplant; 15 more recently, one study demonstrated that a low baseline SAI score increased the risk of graft loss post-transplant. 16 However, to date, there is a lack of studies analyzing the impact of follow up SAI score on post-transplant outcomes and assessing if these associations differ by race.…”