Sharad I Wadhwani1, Jin Ge2, Laura Gottlieb3, Courtney Lyles2, Andrew F Beck4,5, John Bucuvalas6,7, John Neuhaus8, Uma Kotagal4,5, Jennifer C Lai2. 1. Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA. 2. Department of Medicine, University of California, San Francisco, California, USA. 3. Department of Family and Community Medicine, University of California, San Francisco, California, USA. 4. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. 5. Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 6. Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 7. Department of Pediatrics, Kravis Children's Hospital at Mount Sinai, New York, New York, USA. 8. Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
Abstract
BACKGROUND AND AIMS: Racial/ethnic minority children have worse liver transplant (LT) outcomes. We evaluated whether neighborhood socioeconomic deprivation affected associations between race/ethnicity and wait-list mortality. APPROACH AND RESULTS: We included children (age <18) listed 2005-2015 in the Scientific Registry of Transplant Recipients. We categorized patients as non-Hispanic White, Black, Hispanic, and other. We matched patient ZIP codes to a neighborhood socioeconomic deprivation index (range, 0-1; higher values indicate worse deprivation). Primary outcomes were wait-list mortality, defined as death/delisting for too sick, and receipt of living donor liver transplant (LDLT). Competing risk analyses modeled the association between race/ethnicity and wait-list mortality, with deceased donor liver transplant (DDLT) and LDLT as competing risks, and race/ethnicity and LDLT, with wait-list mortality and DDLT as competing risks. Of 7716 children, 17% and 24% identified as Black and Hispanic, respectively. Compared to White children, Black and Hispanic children had increased unadjusted hazard of wait-list mortality (subhazard ratio [sHR], 1.44; 95% CI, 1.18, 1.75 and sHR, 1.48; 95% CI, 1.25, 1.76, respectively). After adjusting for neighborhood deprivation, insurance, and listing laboratory Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease, Black and Hispanic children did not have increased hazard of wait-list mortality (sHR, 1.12; 95% CI, 0.91, 1.39 and sHR, 1.21; 95% CI, 1.00, 1.47, respectively). Similarly, Black and Hispanic children had a decreased likelihood of LDLT (sHR, 0.58; 95% CI, 0.45, 0.75 and sHR, 0.61; 95% CI, 0.49, 0.75, respectively). Adjustment attenuated the effect of Black and Hispanic race/ethnicity on likelihood of LDLT (sHR, 0.79; 95% CI, 0.60, 1.02 and sHR, 0.89; 95% CI, 0.70, 1.11, respectively). CONCLUSIONS: Household and neighborhood socioeconomic factors and disease severity at wait-list entry help explain racial/ethnic disparities for children awaiting transplant. A nuanced understanding of how social adversity contributes to wait-list outcomes may inform strategies to improve outcomes.
BACKGROUND AND AIMS: Racial/ethnic minority children have worse liver transplant (LT) outcomes. We evaluated whether neighborhood socioeconomic deprivation affected associations between race/ethnicity and wait-list mortality. APPROACH AND RESULTS: We included children (age <18) listed 2005-2015 in the Scientific Registry of Transplant Recipients. We categorized patients as non-Hispanic White, Black, Hispanic, and other. We matched patient ZIP codes to a neighborhood socioeconomic deprivation index (range, 0-1; higher values indicate worse deprivation). Primary outcomes were wait-list mortality, defined as death/delisting for too sick, and receipt of living donor liver transplant (LDLT). Competing risk analyses modeled the association between race/ethnicity and wait-list mortality, with deceased donor liver transplant (DDLT) and LDLT as competing risks, and race/ethnicity and LDLT, with wait-list mortality and DDLT as competing risks. Of 7716 children, 17% and 24% identified as Black and Hispanic, respectively. Compared to White children, Black and Hispanic children had increased unadjusted hazard of wait-list mortality (subhazard ratio [sHR], 1.44; 95% CI, 1.18, 1.75 and sHR, 1.48; 95% CI, 1.25, 1.76, respectively). After adjusting for neighborhood deprivation, insurance, and listing laboratory Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease, Black and Hispanic children did not have increased hazard of wait-list mortality (sHR, 1.12; 95% CI, 0.91, 1.39 and sHR, 1.21; 95% CI, 1.00, 1.47, respectively). Similarly, Black and Hispanic children had a decreased likelihood of LDLT (sHR, 0.58; 95% CI, 0.45, 0.75 and sHR, 0.61; 95% CI, 0.49, 0.75, respectively). Adjustment attenuated the effect of Black and Hispanic race/ethnicity on likelihood of LDLT (sHR, 0.79; 95% CI, 0.60, 1.02 and sHR, 0.89; 95% CI, 0.70, 1.11, respectively). CONCLUSIONS: Household and neighborhood socioeconomic factors and disease severity at wait-list entry help explain racial/ethnic disparities for children awaiting transplant. A nuanced understanding of how social adversity contributes to wait-list outcomes may inform strategies to improve outcomes.
Authors: Cole Brokamp; Andrew F Beck; Neera K Goyal; Patrick Ryan; James M Greenberg; Eric S Hall Journal: Ann Epidemiol Date: 2018-11-29 Impact factor: 3.797
Authors: Sharad Indur Wadhwani; Evelyn K Hsu; Michele L Shaffer; Ravinder Anand; Vicky Lee Ng; John C Bucuvalas Journal: Pediatr Transplant Date: 2019-07-22
Authors: Douglas B Mogul; Xun Luo; Eric K Chow; Allan B Massie; Tanjala S Purnell; Kathleen B Schwarz; Andrew M Cameron; John F P Bridges; Dorry L Segev Journal: J Pediatr Gastroenterol Nutr Date: 2018-03 Impact factor: 2.839
Authors: Amy D Waterman; John D Peipert; Shelley S Hyland; Melanie S McCabe; Emily A Schenk; Jingxia Liu Journal: Clin J Am Soc Nephrol Date: 2013-03-21 Impact factor: 8.237
Authors: Sharad I Wadhwani; Andrew F Beck; John Bucuvalas; Laura Gottlieb; Uma Kotagal; Jennifer C Lai Journal: Am J Transplant Date: 2020-02-06 Impact factor: 8.086
Authors: Rekha V Thammana; Stuart J Knechtle; Rene Romero; Thomas G Heffron; Caroline T Daniels; Rachel E Patzer Journal: Liver Transpl Date: 2013-12-12 Impact factor: 5.799
Authors: Sharad I Wadhwani; John C Bucuvalas; Cole Brokamp; Ravinder Anand; Ashutosh Gupta; Stuart Taylor; Eyal Shemesh; Andrew F Beck Journal: Transplantation Date: 2020-11 Impact factor: 5.385