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)   23 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

Author

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin

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