Faculty Collaboration Database

Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients. Transplantation 2016 Jul;100(7):1550-7

Date

10/02/2015

Pubmed ID

26425875

Pubmed Central ID

PMC4818195

DOI

10.1097/TP.0000000000000931

Scopus ID

2-s2.0-84944339796 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

BACKGROUND: Socioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation. The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of studies analyzing this measure longitudinally or between races.

METHODS: Longitudinal cohort study in adult kidney transplantation transplanted at a single-center between 2005 and 2012. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a minimum of 0 and maximum of 3 for an aggregate of 0 to 15 (higher score → better SES).

RESULTS: One thousand one hundred seventy-one patients were included; 624 (53%) were African American (AA) and 547 were non-AA. African Americans had significantly lower mean baseline SAI scores (AAs 6.5 vs non-AAs 7.8; P < 0.001). Cox regression analysis demonstrated that there was no association between baseline SAI and acute rejection in non-AAs (hazard ratio [HR], 0.92; 95% confidence interval [95% CI], 0.81-1.05), whereas it was a significant predictor of acute rejection in AAs (HR, 0.89; 95% CI, 0.80-0.99). Similarly, a 2-stage approach to joint modelling of time to graft loss and longitudinal SAI did not predict graft loss in non-AAs (HR, 1.01; 95% CI, 0.28-3.62), whereas it was a significant predictor of graft loss in AAs (HR, 0.23; 95% CI, 0.06-0.93).

CONCLUSIONS: After controlling for confounders, SAI scores were associated with a lower risk of acute rejection and graft loss in AA kidney transplant recipients, whereas neither baseline nor follow-up SAI predicted outcomes in non-AA kidney transplant recipients.

Author List

Taber DJ, Hamedi M, Rodrigue JR, Gebregziabher MG, Srinivas TR, Baliga PK, Egede LE

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Employment
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Humans
Immunosuppressive Agents
Kidney Transplantation
Longitudinal Studies
Male
Middle Aged
Multivariate Analysis
Renal Insufficiency
Retrospective Studies
Social Class
Transplant Recipients
Treatment Outcome