Tanjala S Purnell1,2,3, Xun Luo1, Deidra C Crews3,4, Sunjae Bae1,2, Jessica M Ruck1, Lisa A Cooper2,3,5, Morgan E Grams2,4, Macey L Henderson1,3, Madeleine M Waldram1,3, Morgan Johnson1,3, Dorry L Segev1,2,3. 1. Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. 2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 3. Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD. 4. Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. 5. Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
Abstract
BACKGROUND: Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. METHODS: Using data from the Scientific Registry of Transplant Recipients and US Census, we performed multivariable Cox regression to compare outcomes among 18 955 women and 30 887 men who received a first LDKT in 2005-2014 with follow-up through December 31, 2016. RESULTS: Women living in poor (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.13-1.50) and middle-income (aHR, 1.26; 95% CI, 1.14-1.40) neighborhoods had higher risk of graft loss than men, but there were no differences in wealthy areas (aHR, 1.07; 95% CI, 0.88-1.29). Women living in wealthy (aHR, 0.71; 95% CI, 0.59-0.87) and middle-income (aHR, 0.82; 95% CI, 0.74-0.92) neighborhoods incurred a survival advantage over men, but there were no statistically significant differences in mortality in poor areas (aHR, 0.85; 95% CI, 0.72-1.01). CONCLUSIONS: Given our findings that poverty is more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
BACKGROUND: Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. METHODS: Using data from the Scientific Registry of Transplant Recipients and US Census, we performed multivariable Cox regression to compare outcomes among 18 955 women and 30 887 men who received a first LDKT in 2005-2014 with follow-up through December 31, 2016. RESULTS:Women living in poor (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.13-1.50) and middle-income (aHR, 1.26; 95% CI, 1.14-1.40) neighborhoods had higher risk of graft loss than men, but there were no differences in wealthy areas (aHR, 1.07; 95% CI, 0.88-1.29). Women living in wealthy (aHR, 0.71; 95% CI, 0.59-0.87) and middle-income (aHR, 0.82; 95% CI, 0.74-0.92) neighborhoods incurred a survival advantage over men, but there were no statistically significant differences in mortality in poor areas (aHR, 0.85; 95% CI, 0.72-1.01). CONCLUSIONS: Given our findings that poverty is more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
Authors: Megan E Bouchard; Kristin Kan; Yao Tian; Mia Casale; Tracie Smith; Christopher De Boer; Samuel Linton; Fizan Abdullah; Hassan M K Ghomrawi Journal: JAMA Netw Open Date: 2022-02-01
Authors: Asuncion Sancho; Eva Gavela; Julia Kanter; Sandra Beltrán; Cristina Castro; Verónica Escudero; Jonay Pantoja; Pablo Molina; Belen Vizcaíno; Mercedes González; Emma Calatayud; Ana Avila Journal: Front Med (Lausanne) Date: 2022-09-26