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Updated: May 20, 2025
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Published on: July 18, 2014
Trends in survival after heart transplantation based on Social Vulnerability Index in the United States
Lovette Azap1, Adrian Diaz1, Doug A Gouchoe1
1Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Insights
Social vulnerability (SV) significantly impacts long-term heart transplant survival. High or average SV independently increases mortality risk in patients with at least one year post-transplant survival, highlighting persistent disparities.
Area of Science:
- Cardiology
- Transplantation Medicine
- Public Health
Background:
- The long-term impact of social vulnerability (SV) on cardiac transplant survival is not well understood.
- This study investigates the association between SV and survival in heart transplant recipients with at least one year of post-transplant survival.
Purpose of the Study:
- To determine the effect of social vulnerability on long-term survival after heart transplantation.
Main Methods:
- Utilized the United Network for Organ Sharing database (2006-2020) for heart transplant recipients.
- Stratified patients into low, average, and high social vulnerability index (SVI) groups using CDC data.
- Employed Kaplan-Meier survival analysis and multivariable Cox proportional hazard models.
Main Results:
- High SVI patients were more likely to be Black, have diabetes, pre-transplant ICU admission, and require kidney transplants.
- High SVI was associated with longer post-transplant hospital stays.
- Both average and high SVI were independently linked to increased mortality risk (HR 1.12 and 1.16, respectively) after multivariable adjustment.
Conclusions:
- Elevated social vulnerability (average or high SVI) is independently associated with increased mortality in heart transplant recipients with one-year conditional survival.
- These findings underscore the persistence of health disparities in long-term heart transplant outcomes.
Background:
The association of social vulnerability (SV) and cardiac transplant survival remains poorly defined, particularly related to long-term outcomes. The purpose of this study was to define the impact of SV on survival among heart transplant recipients with at least 1 year of survival post-transplant.
Methods:
Heart transplant recipients were identified using the United Network for Organ Sharing database between June 1, 2006, and December 31, 2020. The Center for Disease Control's Social Vulnerability Index (SVI) database was used to stratify patients based on SVI into 3 groups: low: <25; average: 26 to 74; high: 75+. The groups were analyzed with comparative statistics, and unadjusted survival was assessed using Kaplan-Meier methods. To determine the independent association between SVI and survival, a multivariable Cox proportional hazard model was created.
Results:
There were 27,740 recipients identified. High SVI patients more commonly identified as Black individuals and had a higher incidence of diabetes, pretransplant intensive care unit admission, and need for concomitant kidney transplant (p < 0.05 for all). Additionally, high SVI patients had the longest length of stay post-transplant (21.4 days) (p < 0.05). High and average SVI patients had inferior 3-year, 5-year, and 10-year survival vs low SVI patients (p < 0.05). After adjustment, average (hazard ratio [HR]: 1.12) and high (HR: 1.16) SVI were independently associated with an increased risk of mortality on multivariable analysis (both p < 0.001).
Conclusion:
High or average SVI is independently associated with increased mortality following heart transplantation in patients with 1-year conditional survival. These findings demonstrate that disparities persist among heart transplant recipients during long-term follow-up.
