The association of place-based disadvantage and access to deceased donor heart transplantation

US heart transplant candidates from socioeconomically disadvantaged communities have lower access to transplants. The place-based disadvantage index that best captures this disparity is still unknown. We sought to answer this question. We studied all adult heart transplant candidates initially listed between January 1, 2019, and December 31, 2022, using the Scientific Registry of Transplant Recipients. We used competing risk regressions to estimate the association of 4 place-based disadvantage indices (social vulnerability metric, social vulnerability index, area deprivation index [ADI], and distressed communities index) with transplantation and death using models adjusted for characteristics that impact access to transplantation. ADI was significantly associated with receiving a transplant over the greatest range of deciles compared with other indices. Three years after listing, ADI decile 1 patients had a cumulative incidence of 83% of receiving a transplant, compared with 65.8% of decile 10 candidates. Compared with decile 1, decile 10 patients had a 156% greater risk of dying on the waitlist. In this study, we found that ADI was associated with transplantation to a greater extent than other indices studied. The forthcoming continuous distribution provides an opportunity to incorporate ADI to address disparities in heart transplantation.