Mental Health, Neurodegenerative, and Cardiovascular Health of Korean Kidney Transplant Recipients in Single-Person Households.

Abstract

Rationale & objective: The prevalence of single-person households is increasing globally. However, the health of kidney transplant recipients (KTRs) who live alone is underexplored. This study investigated the mental health, neurodegenerative, and cardiovascular health outcomes of KTRs living in single-person households.

Study design: Nationwide retrospective observational cohort study.

Setting & participants: 9,134 KTRs who participated in a national health screening program from 2009 to 2017 and were represented in the Korean National Health Insurance Service (NHIS) data. Subcohorts ranging in size from 3,790 to 7,452 KTRs were constructed for each outcome.

Exposure: Living in single-person household.

Outcome: Composite mental health outcome (depression, anxiety, or insomnia), dementia, Parkinson disease, allograft failure, all-cause mortality, and cardiovascular disease (CVD).

Analytical approach: Multivariable Cox proportional hazards models.

Results: KTRs in single-person households accounted for 10.0% of the study population and were more likely to belong to the lowest income quintile (52.1% vs 18.8%) and less likely to belong to the highest income quintile (9.5% vs 30.9%; P < 0.001). Over a median follow-up period of 6 years, living in a single-person household was associated with a higher risk of the composite mental health outcome (adjusted HR [AHR], 1.28 [95% CI, 1.02-1.60]), with depression showing the strongest individual association (AHR, 1.42 [95% CI, 1.04-1.94]). Single-person households were also associated with a higher risk of dementia (AHR, 1.68 [95% CI, 1.05-2.70]) and Parkinson disease (AHR, 4.40 [95% CI, 1.48-13.09]), as well as a higher risk of CVD (AHR, 1.40 [95% CI, 1.00-1.96]), particularly myocardial infarction (AHR, 1.80 [95% CI, 1.16-2.80]). All-cause mortality and allograft failure rates were comparable between the 2 groups.

Limitations: Retrospective study design, incompleteness of the NHIS database, and potential inaccuracies in the definition of single-person households.

Conclusions: KTRs in single-person households have a higher risk of mental health disorders, dementia, Parkinson disease, and myocardial infarction after kidney transplantation. These findings highlight the need to incorporate comprehensive psychosocial assessments and targeted support into posttransplant care, particularly for socially isolated KTRs.

Plain-language summary: People who live alone after kidney transplantation may face unique health challenges, but this topic has received little attention. We used a large national health insurance database in South Korea to study whether living alone is linked to mental health problems, brain diseases, and heart disease in kidney transplant recipients. We followed thousands of patients for several years and found that those living alone had a higher chance of developing depression, dementia, and heart attacks compared with those living with others. Living alone was also linked to a much higher risk of Parkinson disease. However, the risk of death and kidney allograft failure did not differ between the 2 groups. These findings suggest that transplant clinical care teams should pay closer attention to the social circumstances of patients living alone and provide additional support to help prevent these outcomes.