Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
Division of Cardiology, Emory University Medical Center, Atlanta, Georgia, USA.
Clin Transplant. 2022 Jun;36(6):e14652. doi: 10.1111/ctr.14652. Epub 2022 May 3.
For patients with advanced heart failure, socioeconomic deprivation may impede referral for heart transplantation (HT). We examined the association of socioeconomic deprivation with listing among patients evaluated at our institution and compared this against the backdrop of our local community.
We conducted a retrospective cohort study of patients evaluated for HT between January 2017 and December 2020. Patient demographics and clinical characteristics were recorded. Block group-level area deprivation index (ADI) decile was obtained at each patient's home address and Socioeconomic Status (SES) index was determined by patient zip code.
In total, 400 evaluations were initiated; one international patient was excluded. Among this population, 111 (27.8%) were women, 219 (54.9%) were White, 94 (23.6%) Black, and 59 (14.8%) Hispanic. 248 (62.2%) patients were listed for transplant. Listed patients had significantly higher SES index and lower ADI compared to those who were not listed. However, after adjustment for clinical factors, ADI and SESi were not predictive of listing. Similarly, patient sex, race, and insurance did not influence the likelihood of listing for HT. Notably, the distribution of the referral cohort based on ADI deciles was not reflective of our center's catchment area, indicating opportunities for improving access to transplant for disadvantaged populations.
Although socioeconomic deprivation did not predict listing in our analysis, we recognize the need for broader outreach to combat upstream bias that prevents patients from being referred for HT.
对于晚期心力衰竭患者，社会经济贫困可能会阻碍其接受心脏移植（HT）的转诊。我们研究了社会经济贫困与在我们机构接受评估的患者的列入名单之间的关系，并将其与我们当地社区的背景进行了比较。
我们对 2017 年 1 月至 2020 年 12 月期间接受 HT 评估的患者进行了回顾性队列研究。记录了患者的人口统计学和临床特征。在每个患者的家庭住址获得街区组级别的区域贫困指数（ADI）十分位数，并根据患者邮政编码确定社会经济地位（SES）指数。
总共有 400 次评估被启动；一名国际患者被排除在外。在这一人群中，111 名（27.8%）为女性，219 名（54.9%）为白人，94 名（23.6%）为黑人，59 名（14.8%）为西班牙裔。248 名（62.2%）患者被列入移植名单。与未被列入名单的患者相比，列入名单的患者 SES 指数更高，ADI 更低。然而，在校正临床因素后，ADI 和 SESi 并不能预测列入名单。同样，患者性别、种族和保险状况并不影响 HT 列入名单的可能性。值得注意的是，根据 ADI 十分位数分布的转诊队列与我们中心的服务区域并不相符，这表明有机会改善弱势群体获得移植的机会。
尽管在我们的分析中，社会经济贫困并未预测列入名单，但我们认识到需要更广泛的宣传，以消除阻碍患者接受 HT 转诊的上游偏见。
