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

Abstract

IntroductionAdults 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.MethodsWe 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.ResultsCandidates 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: aHRLDKT = 0.58, 95% CI: 0.55–0.62; aHRpreemptive KT = 0.68, 95% CI: 0.63–0.73; Pinteractions: 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]).ConclusionResidence 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.