Neighborhood socioeconomic deprivation is associated with worse patient and graft survival following pediatric liver transplantation

Abstract

Long‐term outcomes remain suboptimal following pediatric liver transplantation; only one third of children have normal biochemical liver function without immunosuppressant comorbidities 10 years posttransplant. We examined the association between an index of neighborhood socioeconomic deprivation with graft and patient survival using the Scientific Registry of Transplant Recipients. We included children <19 years who underwent liver transplantation between January 1, 2008 to December 31, 2013 (n = 2868). Primary exposure was a neighborhood socioeconomic deprivation index—linked via patient home ZIP code—with a range of 0‐1 (values nearing 1 indicate neighborhoods with greater socioeconomic deprivation). Primary outcome measures were graft failure and death, censored at 10 years posttransplant. We modeled survival using Cox proportional hazards. In univariable analysis, each 0.1 increase in the deprivation index was associated with a 14.3% (95% confidence interval [CI]): 3.8%‐25.8%) increased hazard of graft failure and a 12.5% (95% CI: 2.5%‐23.6%) increased hazard of death. In multivariable analysis adjusted for race, each 0.1 increase in the deprivation index was associated with a 11.5% (95% CI: 1.6%‐23.9%) increased hazard of graft failure and a 9.6% (95% CI: −0.04% to 20.7%) increased hazard of death. Children from high deprivation neighborhoods have diminished graft and patient survival following liver transplantation. Greater attention to neighborhood context may result in improved outcomes for children following liver transplantation.

Do funding sources influence long‐term patient survival in pediatric liver transplantation?

“…Low socioeconomic status creates a milieu of overlapping barriers that negatively affect long‐term well‐being, such as inadequate nutrition, cost‐related medication underuse, impeded access to medication, fewer learning experiences, housing instability, unemployment, and lack of appropriate social networking, to name just a few 21‐23 . As in our study, Wadhwani et al demonstrated that children from deprived neighborhoods who undergo liver transplantation had worse patient and allograft survival 24 . These investigators postulated that social and economic factors impact long‐term outcome.…”

Neighborhood socioeconomic deprivation, racial segregation, and organ donation across 5 states

“…Our exposures were ecological measures of socioeconomic deprivation and racial segregation. They were measured via an index of area‐based socioeconomic deprivation 28‐30 and a racial index of concentration at the extreme 31 (ICE); both available at census tract and ZCTA levels. The socioeconomic deprivation index is composed of 6 measures from the US Census Bureau's 2015 5‐year American Community Survey (ACS): median household income, and fraction of the population below the federal poverty level, adults with a high school education, households receiving public assistance, population with no health insurance, and housing units that are vacant 28 .…”

Ensuring long-term equity after pediatric liver transplantation

“…In “Neighborhood Socioeconomic Deprivation Is Associated with Worse Patient and Graft Survival Following Pediatric Liver Transplantation,” Wadhwani et al used the Nationwide Community Deprivation Index, which is based on the US Census Bureau‐administered American Community Survey. The calculations of neighborhood socioeconomic deprivation are based on the home zip code at the time of transplant as reported to Scientific Registry of Transplant Recipients.…”