Kidney Week

Abstract: SU-OR43

Do Social Determinants of Health Predict Patient-Reported Outcomes in Transplant-Eligible ESRD Patients?

Session Information

• Challenges in Clinical Transplantation
  October 25, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Swift, Samuel Longworth, University of New Mexico, Albuquerque, New Mexico, United States

Samuel Longworth Swift, PhD



Dr. Samuel Swift is a Postdoctoral Scholar at the Center for Healthcare Equity in Kidney Disease at the University of New Mexico, working under his mentor Dr. Larissa Myaskovsky. Dr. Swift is interested in the intersection between health disparities research, social epidemiology, and chronic disease.

• Wang, Shu, University of Florida, Gainesville, Florida, United States

Shu Wang,

• Chang, Chung-Chou H., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Chung-Chou H. Chang,

• Pleis, John R., Centers for Disease Control and Prevention, Hyattsville, Maryland, United States

John R. Pleis,

• Dew, Mary amanda, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Mary amanda Dew,

• Shapiro, Ron, Mount Sinai Health System, New York, New York, United States

Ron Shapiro,

• Unruh, Mark L., University of New Mexico, Albuquerque, New Mexico, United States

Mark L. Unruh,

• Croswell, Emilee J., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Emilee J. Croswell,

• Kendall, Kellee, Highmark Inc, Pittsburgh, Pennsylvania, United States

Kellee Kendall,

• Peipert, John D., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

John D. Peipert,

• Myaskovsky, Larissa, University of New Mexico, Albuquerque, New Mexico, United States

Larissa Myaskovsky,

Background

Measuring and understanding patient reported outcomes [PRO, e.g., health related quality of life (HRQoL) and satisfaction with transplant clinic service] is a critical consideration for the care of kidney transplant (KT) eligible patients with end-stage renal disease (ESRD), because research has demonstrated that pre-transplant HRQoL predicts both the receipt of a KT as well as post-KT mortality. Although research demonstrated the importance of social determinates of health (e.g., cultural factors, psychosocial characteristics, transplant knowledge) on clinical outcomes, less is known about how they predict PRO in KT-eligible ESRD patients.

Methods

We examined whether social determinants of health (Time 1, assessed shortly after initiating KT evaluation) are risk or protective factors for PRO (Time 2, assessed after notification of KT evaluation outcome – accepted or not), controlling for evaluation outcome, in a prospective cohort study. Of the initial 1152 adults referred for KT evaluation (2010-2012), 955 completed a Time 2 interview, most within 1 year of completing KT evaluation [n≤6 months=70% (669), n>6 months to≤12 months=8% (76), n>12 months=22% (210)]. We used the Physical Composite Score (PCS), Mental Health Composite Score (MCS), and Kidney Summary Score (KSS), from the Kidney Disease Quality of Life Short Form (KDQoL-SF) to measure HRQoL, and the Client Satisfaction Questionnaire to measure satisfaction with KT clinic service.

Results

Participants completed KT evaluation in an average of 11.7 months (range= 0-43 months). In adjusted multivariable regression models, a stronger sense of mastery predicted higher PCS (β=4.5, p <0.001), MCS (β=5.4, p<0.001), and KSS (β=5.6, p=<0.001). Depression predicted lower MCS (β=-6.2, p=0.001), and lower KSS (β=-5.1, p=0.002). More medical mistrust predicted lower odds of higher patient satisfaction scores (OR= 0.6, 95% CI=0.4, 0.8, p=0.002).

Conclusion

Transplant teams should consider identifying and targeting patients with a low sense of mastery, greater depressive symptoms, or an increased sense of medical mistrust, with additional psychosocial support to improve PRO during the KT evaluation process.

Funding

• NIDDK Support