TY - JOUR
T1 - Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live-Donor and Preemptive Kidney Transplantation
AU - Li, Yiting
AU - Menon, Gayathri
AU - Kim, Byoungjun
AU - Clark-Cutaia, Maya N.
AU - Long, Jane J.
AU - Metoyer, Garyn T.
AU - Mohottige, Dinushika
AU - Strauss, Alexandra T.
AU - Ghildayal, Nidhi
AU - Quint, Evelien E.
AU - Wu, Wenbo
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara A.
N1 - Publisher Copyright:
© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2024/7
Y1 - 2024/7
N2 - Introduction: Adults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live-donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity. Methods: We studied 403 937 adults (age ≥ 18) KT candidates (national transplant registry; 2006–2021). NDI and its 10 components were averaged at the ZIP-code level. Cause-specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components. Results: Candidates residing in high-deprivation neighborhoods were more likely to be female (40.1% vs. 36.2%) and Black (41.9% vs. 17.7%), and were less likely to receive both LDKT (aHR = 0.66, 95% confidence interval [CI]: 0.64–0.67) and preemptive KT (aHR = 0.60, 95% CI: 0.59–0.62) than those in low-deprivation neighborhoods. These associations differedby race and ethnicity (Black: aHRLDKT = 0.58, 95% CI: 0.55–0.62; aHRpreemptive KT = 0.68, 95% CI: 0.63–0.73; Pinteractions: LDKT < 0.001; Preemptive KT = 0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value): for example, higher median household income (LDKT: aHR = 1.08, 95% CI: 1.07–1.09; Preemptive KT: aHR = 1.10, 95% CI: 1.08–1.11) and educational attainments (≥high school [LDKT: aHR = 1.17, 95% CI: 1.15–1.18; Preemptive KT: aHR = 1.23, 95% CI: 1.21–1.25]). Conclusion: Residence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood-level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.
AB - Introduction: Adults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live-donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity. Methods: We studied 403 937 adults (age ≥ 18) KT candidates (national transplant registry; 2006–2021). NDI and its 10 components were averaged at the ZIP-code level. Cause-specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components. Results: Candidates residing in high-deprivation neighborhoods were more likely to be female (40.1% vs. 36.2%) and Black (41.9% vs. 17.7%), and were less likely to receive both LDKT (aHR = 0.66, 95% confidence interval [CI]: 0.64–0.67) and preemptive KT (aHR = 0.60, 95% CI: 0.59–0.62) than those in low-deprivation neighborhoods. These associations differedby race and ethnicity (Black: aHRLDKT = 0.58, 95% CI: 0.55–0.62; aHRpreemptive KT = 0.68, 95% CI: 0.63–0.73; Pinteractions: LDKT < 0.001; Preemptive KT = 0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value): for example, higher median household income (LDKT: aHR = 1.08, 95% CI: 1.07–1.09; Preemptive KT: aHR = 1.10, 95% CI: 1.08–1.11) and educational attainments (≥high school [LDKT: aHR = 1.17, 95% CI: 1.15–1.18; Preemptive KT: aHR = 1.23, 95% CI: 1.21–1.25]). Conclusion: Residence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood-level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.
KW - live-donor kidney transplantation
KW - neighborhood deprivation
KW - preemptive kidney transplantation
UR - https://www.scopus.com/pages/publications/85197708437
U2 - 10.1111/ctr.15382
DO - 10.1111/ctr.15382
M3 - Article
C2 - 38973768
AN - SCOPUS:85197708437
SN - 0902-0063
VL - 38
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 7
M1 - e15382
ER -