Abstract: TH-PO881
Neighborhood Deprivation and Access to Living Donor Kidney Transplantation: Reducing Health Care Disparities
Session Information
- Transplantation: Donation and Access
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Kim, Byoungjun, New York University Grossman School of Medicine, New York, New York, United States
- Menon, Gayathri, New York University Grossman School of Medicine, New York, New York, United States
- Li, Yiting, New York University Grossman School of Medicine, New York, New York, United States
- Clark-Cutaia, Maya N., New York University Rory Meyers College of Nursing, New York, New York, United States
- Segev, Dorry L., New York University Grossman School of Medicine, New York, New York, United States
- McAdams-DeMarco, Mara, New York University Grossman School of Medicine, New York, New York, United States
Group or Team Name
- NYU Langone Center for Surgical & Transplant Applied Research.
Background
Living donor kidney transplantation (LDKT) offers better health outcomes for individuals with end-stage kidney disease (ESKD). Deprived neighborhoods have low socioeconomic status, limited social cohesion, and reduced access to health care. However, the role of neighborhood deprivation on access to LDKT is understudied.
Methods
We used SRTR data to identify 510,674 non-Hispanic (NH) White, NH Black, NH Asian, and Hispanic KT candidates (age≥18) who were listed for first KT from 1995-2021. The National Cancer Institute's Neighborhood Deprivation Index (NDI) was averaged at the ZIP code level using population weights from the American Community Survey. Proportional hazards models were used to determine the likelihood of LDKT across tertiles of NDI, adjusting for clinical and neighborhood-level factors.
Results
Candidates residing in high-deprivation (HD) neighborhoods had a lower access to LDKT than those in low-deprivation (LD) neighborhoods (adjusted hazard ratio (aHR)=0.80, 95% confidence interval (CI): 0.79-0.82); notably, Black candidates living in HD neighborhoods had 37% lower access to LDKT than those in LD neighborhoods (aHR=0.63, CI: 0.60-0.67). Similarly, Asian and Hispanic candidates living in HD neighborhoods had 22% (aHR: 0.78, CI: 0.70-0.88) and 21% (aHR: 0.79, CI: 0.75-0.83) lower access to LDKT, respectively, relative to White candidates.
Conclusion
Neighborhood deprivation is associated with decreased access to LDKT, particularly among Black candidates. Identification of structural factors impacting healthcare access in disadvantaged neighborhoods can be used by policymakers and healthcare providers to develop interventions to address barriers and disparities in LDKT access.
Funding
- Other NIH Support