Geography, inequities, and the social determinants of health in transplantation

Abstract

Among the causes of inequity in organ transplantation, geography is oft-cited but rarely defined with precision. Traditionally, geographic inequity has been characterized by variation in distance to transplant centers, availability of deceased organ donors, or the consequences of allocation systems that are inherently geographically based. Recent research has begun to explore the use of measures at various geographic levels to better understand how characteristics of a patient’s geographic surroundings contribute to a broad range of transplant inequities. Within, we first explore the relationship between geography, inequities, and the social determinants of health. Next, we review methodologic considerations essential to geographic health research, and critically appraise how these techniques have been applied. Finally, we propose how to use geography to improve access to and outcomes of transplantation.

A Spatial Gaussian-Process Boosting Analysis of Socioeconomic Disparities in Wait-Listing of End-Stage Kidney Disease Patients across the United States

“…We also discovered that though race as main effect, it does not always play a significant role, but in the presence of other minority race types, it has a significant interaction effect towards the percentage of wait-listed ESKD patients. Our findings are consistent with previous clinical studies [3,4,6,8].…”

“…In conclusion, ESKD represents a significant public health challenge in the US, with profound implications for individuals, families, and society [3,7]. Spatial disparities in kidney transplant wait-listing further exacerbate the inequities in access to transplantation, perpetuating disparities in health outcomes.…”

“…Efforts to reduce spatial disparities in kidney transplant wait-listing require a multifaceted approach that addresses the underlying determinants of healthcare access and delivery [3]. This includes expanding access to healthcare services in underserved areas, improving outreach and education about transplantation options, increasing awareness about living donation, and addressing structural barriers to care [4].…”

“…Improving Health Equity: The spatial analysis of kidney donation in ESKD is essential for promoting health equity [3,8]. By identifying and addressing geographic disparities in kidney disease, policymakers and healthcare providers can work towards ensuring that all individuals with ESKD have equal access to transplantation services, regardless of their geographic location or socioeconomic status.…”