The Associations Between Individual-Versus Neighborhood-level Incomes and Kidney Transplant Outcomes.

IF 5 2区医学 Q1 IMMUNOLOGY

Transplantation Pub Date : 2025-09-11 DOI:10.1097/TP.0000000000005486

Tatenda G Mupfudze, Dzhuliyana Handarova, Samantha M Noreen, Sumit Mohan, Jesse D Schold, Darren E Stewart

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引用次数: 0

Abstract

Background: Disparities in posttransplant outcomes persist and worsened during the COVID-19 pandemic, disproportionately affecting individuals with social risk factors. This study examined the total and residual (ie, direct) associations between individual- and neighborhood-level income and posttransplant outcomes among deceased donor kidney transplant (DDKT) and living donor kidney transplant recipients transplanted in the United States in 2020.

Methods: This retrospective cohort study linked Organ Procurement and Transplantation Network data with estimated individual annual income from LexisNexis and neighborhood median annual household income from the American Community Survey. Multivariable Cox models assessed associations between income and 3-y all-cause graft survival, patient survival, and death-censored graft survival.

Results: Among 14 091 DDKT recipients, lower individual income was associated with higher all-cause graft failure (adjusted hazard ratio [aHR] for lowest quartile [Q1] versus highest [Q4]: 1.37; 95% confidence interval [CI], 1.20-1.56) and death (aHR, 1.47; 95% CI, 1.26-1.72). Neighborhood income had weaker associations, though Q1 recipients still had higher all-cause graft failure (aHR, 1.17; 95% CI, 1.03-1.33) and death (aHR, 1.21; 95% CI, 1.04-1.41). In models including both income measures, only individual income remained significant. Censoring COVID-19 deaths attenuated associations for individual income, while neighborhood income was no longer significant. Among 4565 living donor kidney transplant recipients, income was not significantly associated with outcomes.

Conclusions: Lower individual income predicts higher all-cause graft failure, primarily because of increased mortality in DDKT recipients. Neighborhood income has a weaker effect, particularly when censoring COVID-19 deaths. Targeted interventions are needed to improve equity in kidney transplantation, especially during public health crises.

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个人与社区收入水平与肾移植结果的关系。

背景：在2019冠状病毒病大流行期间，移植后预后的差异持续存在并加剧，对具有社会风险因素的个体的影响尤为严重。本研究考察了2020年在美国进行的已故供肾移植（DDKT）和活体供肾移植受者的个人和社区水平收入与移植后结果之间的总体和剩余（即直接）关联。方法：这项回顾性队列研究将器官获取和移植网络数据与LexisNexis估计的个人年收入和美国社区调查的社区家庭年收入中位数联系起来。多变量Cox模型评估了收入与3-y全因移植物生存、患者生存和死亡审查的移植物生存之间的关系。结果：在14,091名DDKT受者中，较低的个人收入与较高的全因移植失败（最低四分位数[Q1]与最高四分位数[Q4]的调整风险比[aHR]: 1.37； 95%可信区间[CI]， 1.20-1.56）和死亡（aHR, 1.47; 95% CI, 1.26-1.72）相关。虽然Q1受体的全因移植失败（aHR, 1.17; 95% CI, 1.03-1.33）和死亡（aHR, 1.21; 95% CI, 1.04-1.41）仍然较高，但邻里收入的相关性较弱。在包括两种收入衡量标准的模型中，只有个人收入仍然重要。审查COVID-19死亡人数削弱了个人收入的关联，而社区收入不再显著。在4565例活体肾移植受者中，收入与预后无显著相关。结论：较低的个人收入预示着更高的全因移植失败，主要是因为DDKT受者死亡率增加。邻里收入的影响较弱，尤其是在审查COVID-19死亡人数时。需要有针对性的干预措施来改善肾移植的公平性，特别是在公共卫生危机期间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.