Tatenda G Mupfudze, Dzhuliyana Handarova, Samantha M Noreen, Sumit Mohan, Jesse D Schold, Darren E Stewart
{"title":"个人与社区收入水平与肾移植结果的关系。","authors":"Tatenda G Mupfudze, Dzhuliyana Handarova, Samantha M Noreen, Sumit Mohan, Jesse D Schold, Darren E Stewart","doi":"10.1097/TP.0000000000005486","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.0000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Associations Between Individual-Versus Neighborhood-level Incomes and Kidney Transplant Outcomes.\",\"authors\":\"Tatenda G Mupfudze, Dzhuliyana Handarova, Samantha M Noreen, Sumit Mohan, Jesse D Schold, Darren E Stewart\",\"doi\":\"10.1097/TP.0000000000005486\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":23316,\"journal\":{\"name\":\"Transplantation\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplantation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/TP.0000000000005486\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TP.0000000000005486","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
The Associations Between Individual-Versus Neighborhood-level Incomes and Kidney Transplant Outcomes.
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.
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.
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