Associations between social determinants of health and abdominal solid organ transplant wait‐lists in the United States. Issue 11 (5th August 2022)

• Record Type: Journal Article
• Authors: Johnson, Wali R.; Rega, Scott A.; Feurer, Irene D.; Karp, Seth J.
• Is Part Of: Clinical transplantation. Volume 36:Issue 11(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-08-05
• Subjects: adult -- kidney -- liver -- social determinants of health -- transplant -- waiting lists; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14784
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Background: Societal factors that influence wait‐listing for transplantation are complex and poorly understood. Social determinants of health (SDOH) affect rates of and outcomes after transplantation. Methods: This cross‐sectional study investigated the impact of SDOH on additions to state‐level, 2017–2018 kidney and liver wait‐lists. Principal components analysis, starting with 127 variables among 3142 counties, was used to derive novel, comprehensive state‐level composites, designated (1) health/economics and (2) community capital/urbanicity. Stepwise multivariate linear regression with backwards elimination ( n = 51; 50 states and DC) tested the effects of these composites, Medicaid expansion, and center density on adult disease burden‐adjusted wait‐list additions. Results: SDOH related to increased community capital/urbanicity were independently associated with wait‐listing (starting models: B = .40, P = .010 Kidney; B = .36, P = .038 Liver) (final models: B = .31, P = .027 Kidney, B = .34, P = .015 Liver). In contrast and surprisingly, no other covariates were associated with wait‐listing ( P ≥ .122). Conclusions: These results suggest that deficits in community resources are important contributors to disparities in wait‐list access. Our composite SDOH metrics may help identify at‐risk communities, which can be the focus of local and national policy initiatives to improve access to organ transplantation.