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Kidney Week

ASN / Education & Meetings / Kidney Week /
Abstract: FR-PO1122

Wait-List Mortality and Deaths Attributed to Social Deprivation Among Kidney Transplant Candidates, 2020-2024

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • McKinney, Warren T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Schladt, David P., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Gladish, Nicole, Stanford University, Stanford, California, United States
  • Lyden, Grace R., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Lentine, Krista L., Saint Louis University School of Medicine, St. Louis, Missouri, United States
  • Israni, Ajay K., The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
Background

Individual-level socioeconomic status (SES) is recognized as a key social determinant of health that impacts access to care and patient outcomes. We aimed to evaluate the association between area-level SES and waitlist mortality among kidney transplant patients, using the social deprivation index.

Methods

This study used data from the Scientific Registry of Transplant Recipients (SRTR) to identify first-time, kidney deceased and living donor candidates added to the waiting list between 2020 and 2024. SDI was calculated using the 2020 – 2024 cycle of the American Community Survey and merged by candidate Zip code. To estimate deaths attributed to SDI in the 5th quintile (most deprived) we used a center adjusted Fine-Gray model to predict the number of deaths within 5 years after listing among patients in the 5th SDI quintile. We then predicted the number of deaths within 5 years after listing in the same cohort, but with their SDI variable set to 1st quintile (least deprived).

Results

We identified 235,597 first-time kidney transplant candidates added to the waiting list between 2020 and 2024. 15.3%, 17.0%, 18.8%, 21.1%, and 27.8% of candidates resided in SDI Q1 (least deprived) through Q5 (most deprived). The total number of deaths and removal from the waitlist since too sick for transplant were 15,100 and 13,335, respectively. (Table 1). Estimated cumulative incidence of deaths at 5 years post-listing in SDI Q5 was 13,236 out of 65,486 candidates. If they had been in Q1, we estimate a cumulative incidence of 13,087 deaths assuming no censoring, suggesting 149 excess deaths attributable to SDI.

Conclusion

Candidates residing in areas with the highest levels of area deprivation represented the largest proportion of patients on the waiting list for kidney transplant. We estimate 149 excess deaths could be attributable to SDI.

Acknowledgment

This work was supported in part by AHRQ RO1 HS028829 (A.I.)

Observed deaths and combined deaths with removal for too sick among kidney transplant candidates by SDI quintile
Social Deprivation Index QuintileObserved Deaths, % (n)Observed Deaths + Removal for too sick, % (n)
All candidates, n - 235,5976.41 (15,100)12.07 (28,435)
Quintile 1 (least deprived)5.70 (2,047)11.22 (4,031)
Quintile 26.11 (2,451)11.60 (4,651)
Quintile 36.27 (2,778)11.93 (5,286)
Quintile 46.53 (3,249)12.31 (6,130)
Quintile 5 (most deprived)6.99 (4,575)12.73 (8,337)

Funding

  • Other U.S. Government Support