Singh Tajinder P, Gauvreau Kimberlee, Bastardi Heather J, Blume Elizabeth D, Mayer John E
Departments of Cardiology and Cardiovascular Surgery, Children's Hospital Boston, Harvard Medical School, and Harvard School of Public Health, Boston, Mass02115, USA.
Circ Heart Fail. 2009 May;2(3):160-5. doi: 10.1161/CIRCHEARTFAILURE.108.800755. Epub 2009 Apr 7.
Socioeconomic (SE) position may affect availability of resources, health-related behavior, and outcomes. We assessed whether patient SE position, determined for the block group of patient residence (average population 1000, smallest census unit with SE data), is associated with graft failure in pediatric heart transplant recipients.
We used the US Census 2000 database to derive a composite SE score for the block group of residence for all patients who underwent their first heart transplant at Children's Hospital Boston between 1991 and 2005 (n=135). Cox proportional hazards models were used to determine the risk of graft failure (death or retransplant) in the lowest tertile SE group (low SE group) compared with the remaining 2 of 3 patients (controls). The 2 groups were similar with respect to age, gender, diagnosis, and year of transplant. White race was less frequent in low SE group (64% versus 90%, P=0.001). Graft failure occurred in 46 transplant recipients (40 deaths, 6 retransplant). Low SE group (hazard ratio 2.4, 95% CI 1.3 to 4.3) and nonwhite race (hazard ratio 2.7, 95% CI 1.4 to 5.2) were both associated with higher risk of graft failure. In a multivariable model controlling for diagnosis and pretransplant support, race, and low SE position (hazard ratio 2.0, 95% CI 1.0 to 3.7, P=0.04) remained associated with graft failure. Low SE position group had a higher incidence rate of graft rejection and was at a higher risk of late rejection.
Low SE position may be an independent risk factor for graft failure in pediatric heart transplant recipients.
社会经济（SE）地位可能会影响资源的可获得性、与健康相关的行为及结果。我们评估了根据患者居住街区组（平均人口1000，具有SE数据的最小普查单位）确定的患者SE地位是否与小儿心脏移植受者的移植物失败相关。
我们使用2000年美国人口普查数据库，为1991年至2005年间在波士顿儿童医院接受首次心脏移植的所有患者（n = 135）的居住街区组得出综合SE评分。采用Cox比例风险模型确定最低三分位数SE组（低SE组）与其余三分之二患者（对照组）相比发生移植物失败（死亡或再次移植）的风险。两组在年龄、性别、诊断和移植年份方面相似。低SE组中白人种族的比例较低（64%对90%，P = 0.001）。46例移植受者发生了移植物失败（40例死亡，6例再次移植）。低SE组（风险比2.4，95%可信区间1.3至4.3）和非白人种族（风险比2.7，95%可信区间1.4至5.2）均与移植物失败风险较高相关。在控制诊断、移植前支持、种族和低SE地位的多变量模型中，低SE地位（风险比2.0，95%可信区间1.0至3.7，P = 0.04）仍与移植物失败相关。低SE地位组的移植物排斥发生率较高，且发生晚期排斥的风险也较高。
低SE地位可能是小儿心脏移植受者移植物失败的一个独立危险因素。
