Abstract
Background. Socioeconomic barriers can prevent successful kidney transplant (KT) but are difficult to measure efficiently in clinical settings. We created and validated an individual-level, single score Kidney Transplant Derailers Index (KTDI) and assessed its association with waitlisting and living donor KT (LDKT) rates. Methods. The dataset included 733 patients presenting for KT evaluation in a transplant center in California. Exploratory factor analysis was used to identify socioeconomic barriers to KT (derailers) to include in the index. Potential KT derailers included health insurance, employment, financial insecurity, educational attainment, perception of neighborhood safety, access to a vehicle, having a washer/ dryer, and quality of social support. Validity was tested with associations between KTDI scores and the following: (1) the Area Deprivation Index (ADI) and (2) time to KT waitlisting and LDKT. Results. Nine derailers were retained, omitting only social support level from the original set. The KTDI was scored by summing the number of derailers endorsed (mean: 3.0; range: 0–9). Black patients had higher estimated KTDI scores than other patient groups (versus White patients, 3.8 versus 2.1; P < 0.001, effect size = 0.81). In addition, the KTDI was associated with the ADI (γ = 0.70, SE = 0.07; P < 0.001). Finally, in comparison to the lower tertile, patients in the upper and middle KTDI tertiles had lower hazard of waitlisting (upper tertile hazard ratio [HR]: 0.34, 95% confidence interval [CI]: 0.25-0.45; middle tertile HR: 0.54, 95% CI: 0.40-0.72) and receiving an LDKT (upper tertile HR: 0.15, 95% CI: 0.08-0.30; middle tertile HR: 0.35, 95% CI: 0.20-0.62). These associations remained significant when adjusting for the ADI and other patient characteristics. Conclusions. The KTDI is a valid indicator of socioeconomic barriers to KT for individual patients that can be used to identify patients at risk for not receiving a KT.
| Original language | English (US) |
|---|---|
| Article number | e497 |
| Journal | Transplantation Direct |
| Volume | 5 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2019 |
Funding
Received 16 May 2019. Revision received 22 June 2019. Accepted 26 June 2019. 1Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. 2Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL. 3 Terasaki Research Institute, University of California, Los Angeles, Los Angeles, CA. 4Department of Psychology, University of Rhode Island, Kingston, RI. 5Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA. This work was supported by NIDDK R01DK088711-01A1 (awarded to A.D.W.), HRSA R39OT26843-01-02 (awarded to A.D.W.), and HRSA R39OT29879 (awarded to A.D.W.). The authors declare no conflicts of interest. J.D.P. conceived the study design, conducted statistical analyses, and led the article drafting. J.L.B. conducted statistical analyses and critically reviewed the article. Y.C. prepared the data and critically reviewed the article. A.D.W.
ASJC Scopus subject areas
- Transplantation