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Abstract: FR-PO798

Transplantation, Waitlist Status, and County Indices of Economic Health in West Virginia

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Shawwa, Khaled, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Chaudhary, Vishy, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Parravani, Anthony J., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Poling, Mark A., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Thompson, Jesse M., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Pellegrino, Bethany S., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Schmidt, Rebecca J., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
Background

Kidney transplantation is the optimal treatment for patients with end stage kidney disease. Many patients are never waitlisted for transplant. West Virginia (WV) has a high poverty rate (PR) (17.1 vs 12.85% for the US) with 33 of its 55 counties recognized as economically distressed or thereby at risk. We searched for a potential association between transplant waitlisting and the receipt of a transplant with indices of economic health.

Methods

Data on initiation of kidney replacement therapy with dialysis or transplant, waitlist for kidney transplant and death between 1965 and 2020 for WV patients were collected from USRDS. Data on county PR and economic distress including composite index (CI) for national economic status were collected from the Appalachian Regional Commission.

Results

Of the 23,055 WV patients identified in USRDS data, 2,999 (13%) were transplanted compared to 514,050 (15.3%) for the rest of the US (p< 0.001). Patients who never received a kidney transplant were from counties with higher PRs (18%) compared to transplanted patients (17.5%); p<0.001. Overall, waitlisted patients (2,375) came from counties with lower PRs than those who were never waitlisted (17.6 vs 18%; p<0.001). Waitlisted patients were less likely to be from distressed or at-risk counties (32 vs 34.3%; p=0.05) or counties with lower CI (141.9 vs 145.2; p<0.001) than patients who were never waitlisted.
Among those who were never transplanted, waitlisted patients (792) came from counties with lower PRs (17.1 vs 18%; p<0.001), less distressed or economically at-risk counties (28.9 vs 34.5%; p=0.003) and counties with a lower CI (139 vs 145.5; p<0.001) than those who were never waitlisted (20,479). In multivariable logistic regression, county PR remained an independent predictor of lower odds of being transplanted (OR 0.91, 95% CI: 0.85-0.97; p=0.005) or waitlisted (OR 0.9, 95% CI: 0.84-0.96; p=0.001) per 5% increase in poverty rate after adjusting for age, sex, BMI, tobacco use, functional status, comorbid medical conditions and drug dependence.

Conclusion

Waitlisted patients and transplant recipients from WV were more likely to hail from counties with lower PRs and those in better economic health.