The Associations Between Individual-Versus Neighborhood-level Incomes and Kidney Transplant Outcomes

Area of Science:

• Nephrology
• Transplantation
• Health Equity

Background:

• Persistent disparities in posttransplant outcomes disproportionately affect individuals with social risk factors.
• The COVID-19 pandemic exacerbated existing inequities in kidney transplant care.
• Understanding the impact of socioeconomic status on transplant outcomes is crucial for improving patient care.

Purpose of the Study:

• To examine the associations between individual and neighborhood income and posttransplant outcomes.
• To differentiate the effects of individual versus neighborhood income on kidney transplant success.
• To assess these associations in both deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) recipients.

Main Methods:

• Retrospective cohort study linking Organ Procurement and Transplantation Network data.
• Individual income estimated from LexisNexis; neighborhood income from American Community Survey.
• Multivariable Cox models used to assess associations with 3-year all-cause graft survival, patient survival, and death-censored graft survival.

Main Results:

• Lower individual income was significantly associated with higher graft failure and mortality in DDKT recipients.
• Neighborhood income showed weaker associations, and its significance diminished when considering individual income.
• Associations were attenuated when censoring COVID-19 deaths, particularly for neighborhood income; no significant income associations were found for LDKT recipients.

Conclusions:

• Lower individual income is a significant predictor of adverse outcomes, primarily increased mortality, in DDKT recipients.
• Neighborhood income has a less pronounced effect, especially when accounting for COVID-19 deaths.
• Targeted interventions are essential to enhance equity in kidney transplantation, particularly during public health emergencies.