Associations between social determinants of health and abdominal solid organ transplant wait-lists in the United States

• Published in: Clinical transplantation Vol. 36; no. 11; p. e14784
• Main Authors: Johnson, Wali R, Rega, Scott A, Feurer, Irene D, Karp, Seth J
• Format: Journal Article
• Language: English
• Published: Denmark 01-11-2022
• Subjects: Adult; Cross-Sectional Studies; Humans; Organ Transplantation; Social Determinants of Health; United States; Waiting Lists; United States; kidney; transplant; social determinants of health; adult; liver; waiting lists
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.14784

Societal factors that influence wait-listing for transplantation are complex and poorly understood. Social determinants of health (SDOH) affect rates of and outcomes after transplantation.
This cross-sectional study investigated the impact of SDOH on additions to state-level, 2017-2018 kidney and liver wait-lists. Principal components analysis, starting with 127 variables among 3142 counties, was used to derive novel, comprehensive state-level composites, designated (1) health/economics and (2) community capital/urbanicity. Stepwise multivariate linear regression with backwards elimination (n = 51; 50 states and DC) tested the effects of these composites, Medicaid expansion, and center density on adult disease burden-adjusted wait-list additions.
SDOH related to increased community capital/urbanicity were independently associated with wait-listing (starting models: B = .40, P = .010 Kidney; B = .36, P = .038 Liver) (final models: B = .31, P = .027 Kidney, B = .34, P = .015 Liver). In contrast and surprisingly, no other covariates were associated with wait-listing (P ≥ .122).
These results suggest that deficits in community resources are important contributors to disparities in wait-list access. Our composite SDOH metrics may help identify at-risk communities, which can be the focus of local and national policy initiatives to improve access to organ transplantation.