TY - JOUR
T1 - Neighborhood Poverty and Sex Differences in Live Donor Kidney Transplant Outcomes in the United States
AU - Purnell, Tanjala S.
AU - Luo, Xun
AU - Crews, Deidra C.
AU - Bae, Sunjae
AU - Ruck, Jessica M.
AU - Cooper, Lisa A.
AU - Grams, Morgan E.
AU - Henderson, Macey L.
AU - Waldram, Madeleine M.
AU - Johnson, Morgan
AU - Segev, Dorry L.
N1 - Funding Information:
3Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD. 4Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. 5Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. The authors declare no conflicts of interest. The authors were supported by grant K01HS024600 (principal investigator [PI]: T.S.P.) from the Agency for Healthcare Research and Quality; by grants K24DK101828 (PI: D.L.S.), K23DK097184 (PI: D.C.C.), K08DK092287 (PI: M.E.G.), and K01DK114388-01 (PI:M.L.H.) from the National Institute of Diabetes and Digestive and Kidney Diseases; by grant K24HL083113 (PI: L.A.C.) from the National Heart, Lung and Blood Institute; and by a Doris Duke Clinical Research Mentorship grant (J.M.R. and D.L.S.). The funders had no role in the design and conduct of the study, interpretation of the data, or preparation of the manuscript.
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background. Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. Methods. Using data from the Scientific Registry of Transplant Recipients and US Census, we performed multivariable Cox regression to compare outcomes among 18 955 women and 30 887 men who received a first LDKT in 2005-2014 with follow-up through December 31, 2016. Results. Women living in poor (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.13-1.50) and middle-income (aHR, 1.26; 95% CI, 1.14-1.40) neighborhoods had higher risk of graft loss than men, but there were no differences in wealthy areas (aHR, 1.07; 95% CI, 0.88-1.29). Women living in wealthy (aHR, 0.71; 95% CI, 0.59-0.87) and middle-income (aHR, 0.82; 95% CI, 0.74-0.92) neighborhoods incurred a survival advantage over men, but there were no statistically significant differences in mortality in poor areas (aHR, 0.85; 95% CI, 0.72-1.01). Conclusions. Given our findings that poverty is more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
AB - Background. Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. Methods. Using data from the Scientific Registry of Transplant Recipients and US Census, we performed multivariable Cox regression to compare outcomes among 18 955 women and 30 887 men who received a first LDKT in 2005-2014 with follow-up through December 31, 2016. Results. Women living in poor (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.13-1.50) and middle-income (aHR, 1.26; 95% CI, 1.14-1.40) neighborhoods had higher risk of graft loss than men, but there were no differences in wealthy areas (aHR, 1.07; 95% CI, 0.88-1.29). Women living in wealthy (aHR, 0.71; 95% CI, 0.59-0.87) and middle-income (aHR, 0.82; 95% CI, 0.74-0.92) neighborhoods incurred a survival advantage over men, but there were no statistically significant differences in mortality in poor areas (aHR, 0.85; 95% CI, 0.72-1.01). Conclusions. Given our findings that poverty is more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
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U2 - 10.1097/TP.0000000000002654
DO - 10.1097/TP.0000000000002654
M3 - Article
C2 - 30768570
AN - SCOPUS:85072745677
SN - 0041-1337
VL - 103
SP - 2183
EP - 2189
JO - Transplantation
JF - Transplantation
IS - 10
ER -