居民区贫困程度及其对活体肾移植和先期肾移植可能性的影响。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-07-08 DOI:10.1111/ctr.15382

Yiting Li, Gayathri Menon, Byoungjun Kim, Maya N. Clark-Cutaia, Jane J. Long, Garyn T. Metoyer, Dinushika Mohottige, Alexandra T. Strauss, Nidhi Ghildayal, Evelien E. Quint, Wenbo Wu, Dorry L. Segev, Mara A. McAdams-DeMarco

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引用次数: 0

摘要

导言：居住在贫困社区的成年人面临着各种社会经济压力，阻碍了他们接受活体供肾移植（LDKT）和先期肾移植（KT）的可能性。我们量化了居住区贫困指数（NDI）与接受活体供肾移植/肾脏移植前期治疗的可能性之间的关系，并检测了种族和民族的不同影响：我们研究了 403 937 名成人（年龄≥ 18 岁）KT 候选人（国家移植登记处；2006-2021 年）。在邮政编码水平上对 NDI 及其 10 个组成部分进行了平均。使用病因特异性危险模型来量化不同NDI及其10个分量的LDKT和先期KT的调整危险比（aHR）：居住在高贫困社区的候选者更有可能是女性（40.1% 对 36.2%）和黑人（41.9% 对 17.7%），与居住在低贫困社区的候选者相比，他们接受低密度KT（aHR = 0.66，95% 置信区间 [CI]：0.64-0.67）和抢先 KT（aHR = 0.60，95% 置信区间：0.59-0.62）的可能性更低。这些关联因种族和民族而异（黑人：aHRLDKT = 0.58，95% CI：0.55-0.62；aHR-抢先 KT = 0.68，95% CI：0.63-0.73；平特互动：aHRLDKT = 0.58，95% CI：0.55-0.62；平特互动：aHR-抢先 KT = 0.68，95% CI：0.63-0.73）：结论居住在社会经济贫困的社区与较低的 LDKT 和抢先 KT 可能性有关，对少数族裔候选人的影响不同。识别和了解哪些社区层面的社会经济状况会导致这些种族差异，有助于调整干预措施，以实现 LDKT 和抢先 KT 的健康公平。

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Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live-Donor and Preemptive Kidney Transplantation

Introduction

Adults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live-donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity.

Methods

We studied 403 937 adults (age ≥ 18) KT candidates (national transplant registry; 2006–2021). NDI and its 10 components were averaged at the ZIP-code level. Cause-specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components.

Results

Candidates residing in high-deprivation neighborhoods were more likely to be female (40.1% vs. 36.2%) and Black (41.9% vs. 17.7%), and were less likely to receive both LDKT (aHR = 0.66, 95% confidence interval [CI]: 0.64–0.67) and preemptive KT (aHR = 0.60, 95% CI: 0.59–0.62) than those in low-deprivation neighborhoods. These associations differedby race and ethnicity (Black: aHR_LDKT = 0.58, 95% CI: 0.55–0.62; aHR_{preemptive KT} = 0.68, 95% CI: 0.63–0.73; P_interactions: LDKT < 0.001; Preemptive KT = 0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value): for example, higher median household income (LDKT: aHR = 1.08, 95% CI: 1.07–1.09; Preemptive KT: aHR = 1.10, 95% CI: 1.08–1.11) and educational attainments (≥high school [LDKT: aHR = 1.17, 95% CI: 1.15–1.18; Preemptive KT: aHR = 1.23, 95% CI: 1.21–1.25]).

Conclusion

Residence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood-level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.