County socioeconomic characteristics and pediatric renal transplantation outcomes

Miller, Rebecca; Akateh, Clifford; Thompson, Noelle; Tumin, Dmitry; Hayes, Don; Black, Sylvester M.; Tobias, Joseph D.

doi:10.1007/s00467-018-3928-0

Cited by 14 publications

(8 citation statements)

References 39 publications

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“…Six studies examined country and regional SES and post‐transplant outcomes. Several found no significant differences by country or regional income levels, including no differences in rejection or graft survival in Australia, 59 the US, 91 and European countries 57 . However, greater risk of graft failure was associated with geographic deprivation in France 60 .…”

Section: Resultsmentioning

confidence: 97%

“…Patients with Medicaid or public insurance had longer length of stay post-transplant, 86 higher rates of induction therapy at discharge, 12 and increased risk of graft failure, 16 although studies related to graft survival were not consistent. 84,85,91 Additionally, two studies found higher rates of mortality among patients with public compared to private insurance, including significant interactions between insurance and donor type, such that the highest rates of mortality were found among patients with deceased donors and public insurance. 75,84 Caregivers of adolescents on Medicaid reported greater scheduling and ingestion/side effect barriers to adherence compared to caregivers of younger patients also on Medicaid, while no differences were observed among those with non-Medicaid insurance.…”

Section: Insurancementioning

confidence: 99%

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A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

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Background: Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre-and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods. Methods: Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases. Results: Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent. Conclusion: This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities. K E Y W O R D S social determinants of health, disparity, pediatric organ transplantation 2 of 33 | REA et al. 1 | INTRODUC TI ON Equitable access to organ transplantation and subsequent transplantrelated medical care is a critical goal across healthcare centers. Over the years, studies have identified risk factors impacting listing status and transplant-related outcomes, with greater scrutiny recently on clinical tools impacting organ allocation, selection, and donation processes. 1 These steps are critical in identifying areas of structural racism which continue to impact Black, Indigenous, and people of color as well as the intersectionality of socioeconomic factors within the patient population as a whole. To summarize findings to date, a systematic review of the available literature was conducted. Studies included assessments of SDoH in the evaluation, listing, and post-transplant periods. The US Department of Health and Human Services identifies five domains of SDoH that include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. 2 Special consideration was given to dynamic interplay between these factors to better understand social processes underlying health outcomes and identify potential intervention areas. | ME THODS | Search strategyThis systematic review is in accordance with PRISMA guidelines.Comprehensive search strategies were created for Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature, including controlled vocabulary terms from each database combined logically with keywords using Boolean Logic. Terms were extracted per the following concepts: pediatrics, organ transplantation, disparities, and identity (see example searc...

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Section: Resultsmentioning

confidence: 97%

Section: Insurancementioning

confidence: 99%

A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

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“…Overall, in these studies, a higher level of deprivation was associated with a lower access to the transplant waiting list and a shorter kidney graft survival. 12,13 Conversely, Miller et al 16 recently studied the correlation between US county-level socioeconomic status and 1-year pediatric kidney transplant outcomes and showed no conclusive evidence of a relationship. Authors of a previous study conducted in Australia found that remoteness had an impact on receiving a preemptive transplant, but no association between socioeconomic status and transplant outcome has been shown.…”

Section: Discussionmentioning

confidence: 99%

Social deprivation is associated with poor kidney transplantation outcome in children

Driollet

Bayer

Châtelet

et al. 2019

Kidney International

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“…For every US$1000 increase in GDP per capita, the kidney transplant rate increased by 0.2 [ 13 ]. However, analysis of geographic measures of socioeconomic status from the United Nations Organ Sharing (UNOS) registry data revealed that socioeconomic status did not predict 1-year paediatric kidney transplant outcomes [ 17 ]. In LLMIC, in addition to economic disparities, access to transplantation to an extent is influenced by racial, ethnic and geographical disparities [ 18 – 20 ].…”

Section: Access To Kidney Transplantationmentioning

confidence: 99%

Paediatric kidney transplantation in under-resourced regions—a panoramic view

Iyengar

McCulloch

2021

Pediatr Nephrol

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Kidney transplantation is the ideal choice of kidney replacement therapy in children as it offers a low risk of mortality and a better quality of life. A wide variance in the access to kidney replacement therapies exists across the world with only 21% of low- and low-middle income countries (LLMIC) undertaking kidney transplantation. Pediatric kidney transplantation rates in these under-resourced regions are reported to be as low as < 4 pmcp [per million child population]. A robust kidney failure care program forms the cornerstone of a transplant program. Even the smallest transplant program entails a multidisciplinary workforce and expertise besides ensuring family commitment towards long-term care and economic burden. In general, the short-term graft survival rates from under-resourced regions are comparable to most high-income countries (HIC) and the challenge lies in the long-term outcomes. This review focuses on specific issues relevant to kidney transplants in children in under-resourced regions by highlighting limitations in the capacity and health workforce, regulatory norms, medical issues, economic burden, factors beyond financial hardship and ethical considerations relevant to these regions. Finally, the perspective of strengthening transplant programs in these regions should factor in the bigger challenges that exist in achieving the health-related sustainable development goals by 2030.

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County socioeconomic characteristics and pediatric renal transplantation outcomes

Abstract: Pediatric kidney transplant outcomes are unstable from period to period at the county level and are not correlated with county-level SES. Appropriate adjustment for SES disparities in transplant outcomes could require further collection of detailed individual SES data.

Cited by 14 publications

References 39 publications

A systematic review of social determinants of health in pediatric organ transplant outcomes

A systematic review of social determinants of health in pediatric organ transplant outcomes

Social deprivation is associated with poor kidney transplantation outcome in children

Paediatric kidney transplantation in under-resourced regions—a panoramic view

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