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Abstract: SA-PO800

Geographic Hot Spots of Post-Dialysis Kidney Transplant Waitlisting Are Associated With Socioeconomic Deprivation

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical


  • Buchalter, Robert B., Cleveland Clinic, Cleveland, Ohio, United States
  • Huml, Anne M., Cleveland Clinic, Cleveland, Ohio, United States
  • Poggio, Emilio D., Cleveland Clinic, Cleveland, Ohio, United States
  • Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States

Wait-listing of deceased donor kidney transplant candidates before maintenance dialysis improves outcomes. Preemptive listing disparities have not been examined with geospatial methods, so identifying hot spot areas where post-dialysis wait-listing is most prevalent is a first step towards localizing interventions and health policy. Socioeconomic deprivation is linked to post-dialysis wait-listing but has not been studied in the context of geographic hot spots, suggesting an opportunity to examine differences in deprivation between post-dialysis wait-listing hot spots and non-hot spots.


We used 2010-2020 zip code tabulation area-level SRTR deceased donor kidney transplant candidate data and 3 geospatial cluster analysis methods to identify statistically significant post-dialysis wait-listing hot spots. We classified ZCTAs by area deprivation index quartile derived from 2010-2019 ACS 5-year estimates and computed odds ratios and 95% confidence intervals comparing deprivation values in hot spots and non-hot spots.


We identified hot spots in southeastern, southwestern, and California ZCTAs, with most hot spots occurring in the southeast (Figure 1). Hot spot ZCTAs were more likely to be in the highest deprivation quartile (OR: 6.76, 95%CI: 6.52-7.02) compared to non-hot spot ZCTAs.


Our results reveal novel small area post-dialysis kidney transplant wait-listing disparity patterns where clinical interventions and health policies can be targeted. Our work is the first to identify localized preemptive listing disparities and the first to identify geographic preemptive listing disparities in California. The strong link between post-dialysis wait-listing hot spots and socioeconomic deprivation reflects previous findings but sheds new light by integrating geography.

Figure 1: ZCTA hot spots of kidney transplant candidates wait-listed post-dialysis, 2010-2020


  • Other NIH Support