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Socioeconomic Disparities in Adherence and Outcomes After Heart Transplant
Circulation: Heart Failure ( IF 9.7 ) Pub Date : 2018-03-01 , DOI: 10.1161/circheartfailure.117.004173
Brian Wayda 1 , Autumn Clemons 1 , Raymond C Givens 1 , Koji Takeda 1 , Hiroo Takayama 1 , Farhana Latif 1 , Susan Restaino 1 , Yoshifumi Naka 1 , Maryjane A Farr 1 , Paolo C Colombo 1 , Veli K Topkara 1
Affiliation  

Background: There is mixed evidence of racial and socioeconomic disparities in heart transplant outcomes. Their underlying cause—and whether individual- or community-level traits are most influential—remains unclear. The current study aimed to characterize socioeconomic disparities in outcomes and identify time trends and mediators of these disparities.
Methods and Results: We used United Network for Organ Sharing registry data and included 33 893 adult heart transplant recipients between 1994 and 2014. Socioeconomic status (SES) indicators included insurance, education, and neighborhood SES measured using a composite index. Black race and multiple indicators of low SES were associated with the primary outcome of death or retransplant, independent of baseline clinical characteristics. Blacks had lower HLA and race matching, but further adjustment for these and other graft characteristics only slightly attenuated the association with black race (HR, 1.25 after adjustment). This and the associations with neighborhood SES (HR, 1.19 for lowest versus highest decile), Medicare (HR, 1.17), Medicaid (HR, 1.29), and college education (HR, 0.90) remained significant after full adjustment. When comparing early (1994–2000) and late (2001–2014) cohorts, the disparities associated with the middle (second and third) quartiles significantly decreased over time, but those associated with lowest SES quartile and black race persisted. Low neighborhood SES was also associated with higher risks of noncompliance (HR, 1.76), rejection (HR, 1.28), hospitalization (HR, 1.13), and infection (HR, 1.10).
Conclusions: Racial and socioeconomic disparities exist in heart transplant outcomes, but the latter may be narrowing over time. These disparities are not explained by differences in clinical or graft characteristics.


中文翻译:

心脏移植后依从性和结果的社会经济差异

背景:心脏移植结果存在种族和社会经济差异的混合证据。它们的根本原因——以及个人或社区层面的特征是否最具影响力——仍不清楚。目前的研究旨在表征结果中的社会经济差异,并确定这些差异的时间趋势和中介因素。
方法和结果:我们使用了器官共享联合网络注册数据,并纳入了 1994 年至 2014 年间的 33 893 名成人心脏移植受者。社会经济状况 (SES) 指标包括使用综合指数衡量的保险、教育和社区 SES。黑人种族和多个低 SES 指标与死亡或再移植的主要结果相关,与基线临床特征无关。黑人具有较低的 HLA 和种族匹配,但对这些和其他移植特征的进一步调整只会略微减弱与黑人种族的关联(调整后 HR,1.25)。这与社区 SES(最低和最高十分位数的 HR,1.19)、医疗保险(HR,1.17)、医疗补助(HR,1.29)和大学教育(HR,0.90)的关联在完全调整后仍然显着。在比较早期(1994-2000)和晚期(2001-2014)队列时,与中间(第二和第三)四分位数相关的差异随着时间的推移显着减少,但与最低 SES 四分位数和黑人种族相关的差异仍然存在。低社区 SES 还与较高的不依从性(HR,1.76)、排斥(HR,1.28)、住院(HR,1.13)和感染(HR,1.10)风险相关。
结论:心脏移植结果存在种族和社会经济差异,但后者可能会随着时间的推移而缩小。这些差异不能用临床或移植物特征的差异来解释。
更新日期:2018-03-22
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