Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
Pediatr Nephrol. 2018 Jul;33(7):1227-1234. doi: 10.1007/s00467-018-3928-0. Epub 2018 Mar 12.
Existing risk adjustment models for solid organ transplantation omit socioeconomic status (SES). With limited data available on transplant candidates' SES, linkage of transplant outcomes data to geographic SES measures has been proposed. We investigate the utility of county SES for understanding differences in pediatric kidney transplantation (KTx) outcomes.
We identified patients < 18 years of age receiving first-time KTx using United Network for Organ Sharing registry data in two eras: 2006-2010 and 2011-2015, corresponding to periods of county SES data collection. In each era, counties were ranked by 1-year rates of survival with intact graft, and by county SES score. We used Spearman correlation (ρ) to evaluate the association between county rankings on SES and transplant outcomes in each era and consistency between these measures across eras. We also evaluated the utility of county SES for improving prediction of individual KTx outcomes.
The analysis included 2972 children and 108 counties. County SES and transplant outcomes were not correlated in either 2006-2010 (ρ = 0.06; p = 0.525) or 2011-2015 (ρ = 0.162, p = 0.093). County SES rankings were strongly correlated between eras (ρ = 0.99, p < 0.001), whereas county rankings of transplant outcomes were not correlated between eras (ρ = 0.16, p = 0.097). Including county SES quintile in individual-level models of transplant outcomes did not improve model predictive utility.
Pediatric kidney transplant outcomes are unstable from period to period at the county level and are not correlated with county-level SES. Appropriate adjustment for SES disparities in transplant outcomes could require further collection of detailed individual SES data.
现有的实体器官移植风险调整模型忽略了社会经济地位（SES）。由于可供移植候选人 SES 数据有限，因此提出了将移植结果数据与地理 SES 度量值进行链接。我们研究了县 SES 对理解儿科肾移植（KTx）结果差异的作用。
我们使用 United Network for Organ Sharing 登记数据，在两个时期内确定了年龄均<18 岁的首次接受 KTx 的患者：2006-2010 年和 2011-2015 年，分别对应于县 SES 数据收集时期。在每个时期，根据 1 年存活率和完整移植物以及县 SES 评分对县进行排名。我们使用 Spearman 相关系数（ρ）来评估 SES 县排名与每个时期的移植结果之间的相关性以及这些措施在各时期之间的一致性。我们还评估了县 SES 对改善个体 KTx 结果预测的作用。
分析共纳入了 2972 名儿童和 108 个县。在 2006-2010 年（ρ=0.06；p=0.525）或 2011-2015 年（ρ=0.162，p=0.093）期间，县 SES 和移植结果均不相关。两个时期的县 SES 排名高度相关（ρ=0.99，p<0.001），而两个时期的移植结果的县排名不相关（ρ=0.16，p=0.097）。在个体移植结果模型中包含县 SES 五分位数并不能提高模型的预测能力。
儿科肾移植结果在县一级随时间变化而不稳定，与县一级 SES 无关。要适当调整移植结果中的 SES 差异，可能需要进一步收集详细的个人 SES 数据。
