Taber David J, Hamedi Mahsa, Rodrigue James R, Gebregziabher Mulugeta G, Srinivas Titte R, Baliga Prabhakar K, Egede Leonard E
1 Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC. 2 Department of Pharmacy, Ralph H Johnson VAMC, Charleston, SC. 3 College of Medicine, Medical University of South Carolina, Charleston, SC. 4 Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 5 Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC. 6 Division of Transplant Nephrology, College of Medicine, Medical University of South Carolina, Charleston, SC. 7 Veterans Affairs HSR&D Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H Johnson VAMC, Charleston, SC.
Transplantation. 2016 Jul;100(7):1550-7. doi: 10.1097/TP.0000000000000931.
Socioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation. The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of studies analyzing this measure longitudinally or between races.
Longitudinal cohort study in adult kidney transplantation transplanted at a single-center between 2005 and 2012. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a minimum of 0 and maximum of 3 for an aggregate of 0 to 15 (higher score → better SES).
One thousand one hundred seventy-one patients were included; 624 (53%) were African American (AA) and 547 were non-AA. African Americans had significantly lower mean baseline SAI scores (AAs 6.5 vs non-AAs 7.8; P < 0.001). Cox regression analysis demonstrated that there was no association between baseline SAI and acute rejection in non-AAs (hazard ratio [HR], 0.92; 95% confidence interval [95% CI], 0.81-1.05), whereas it was a significant predictor of acute rejection in AAs (HR, 0.89; 95% CI, 0.80-0.99). Similarly, a 2-stage approach to joint modelling of time to graft loss and longitudinal SAI did not predict graft loss in non-AAs (HR, 1.01; 95% CI, 0.28-3.62), whereas it was a significant predictor of graft loss in AAs (HR, 0.23; 95% CI, 0.06-0.93).
After controlling for confounders, SAI scores were associated with a lower risk of acute rejection and graft loss in AA kidney transplant recipients, whereas neither baseline nor follow-up SAI predicted outcomes in non-AA kidney transplant recipients.
社会经济地位（SES）是健康结果的一个重要决定因素，可能是围绕肾移植种族差异的因果链中的一个重要组成部分。社会适应性指数（SAI）是一种经过验证且可量化的SES衡量指标，缺乏纵向或种族间分析该指标的研究。
对2005年至2012年在单中心接受成人肾移植的患者进行纵向队列研究。SAI评分包括5个领域（就业、教育、婚姻状况、药物滥用和收入），每个领域最低0分，最高3分，总分0至15分（分数越高→SES越好）。
纳入1171例患者；624例（53%）为非裔美国人（AA），547例为非AA。非裔美国人的平均基线SAI评分显著较低（AA为6.5，非AA为7.8；P<0.001）。Cox回归分析表明，基线SAI与非AA患者的急性排斥反应之间无关联（风险比[HR]，0.92；95%置信区间[95%CI]，0.81-1.05），而它是AA患者急性排斥反应的显著预测因素（HR，0.89；95%CI，0.80-0.99）。同样，对移植物丢失时间和纵向SAI进行联合建模的两阶段方法不能预测非AA患者的移植物丢失（HR，1.01；95%CI，0.28-3.62），而它是AA患者移植物丢失的显著预测因素（HR，0.23；95%CI，0.06-0.93）。
在控制混杂因素后，SAI评分与AA肾移植受者急性排斥反应和移植物丢失风险较低相关，而非AA肾移植受者的基线和随访SAI均不能预测结局。
