Johnson Wali R, Rega Scott A, Feurer Irene D, Karp Seth J
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Clin Transplant. 2022 Nov;36(11):e14784. doi: 10.1111/ctr.14784. Epub 2022 Aug 5.
Societal factors that influence wait-listing for transplantation are complex and poorly understood. Social determinants of health (SDOH) affect rates of and outcomes after transplantation.
This cross-sectional study investigated the impact of SDOH on additions to state-level, 2017-2018 kidney and liver wait-lists. Principal components analysis, starting with 127 variables among 3142 counties, was used to derive novel, comprehensive state-level composites, designated (1) health/economics and (2) community capital/urbanicity. Stepwise multivariate linear regression with backwards elimination (n = 51; 50 states and DC) tested the effects of these composites, Medicaid expansion, and center density on adult disease burden-adjusted wait-list additions.
SDOH related to increased community capital/urbanicity were independently associated with wait-listing (starting models: B = .40, P = .010 Kidney; B = .36, P = .038 Liver) (final models: B = .31, P = .027 Kidney, B = .34, P = .015 Liver). In contrast and surprisingly, no other covariates were associated with wait-listing (P ≥ .122).
These results suggest that deficits in community resources are important contributors to disparities in wait-list access. Our composite SDOH metrics may help identify at-risk communities, which can be the focus of local and national policy initiatives to improve access to organ transplantation.
影响移植等待名单的社会因素复杂且鲜为人知。健康的社会决定因素（SDOH）会影响移植的发生率和术后结果。
这项横断面研究调查了SDOH对2017 - 2018年州级肾脏和肝脏等待名单增加情况的影响。从3142个县的127个变量开始，采用主成分分析来得出新的、全面的州级综合指标，分别命名为（1）健康/经济和（2）社区资本/城市化程度。采用逐步多元线性回归及向后剔除法（n = 51；50个州和哥伦比亚特区）来测试这些综合指标、医疗补助扩大以及中心密度对成人疾病负担调整后的等待名单增加情况的影响。
与社区资本/城市化程度增加相关的SDOH与进入等待名单独立相关（初始模型：肾脏：B = 0.40，P = 0.010；肝脏：B = 0.36，P = 0.038）（最终模型：肾脏：B = 0.31，P = 0.027；肝脏：B = 0.34，P = 0.015）。相比之下且令人惊讶的是，没有其他协变量与进入等待名单相关（P≥0.122）。
这些结果表明社区资源的不足是等待名单获取差异的重要因素。我们的综合SDOH指标可能有助于识别高危社区，这些社区可以成为地方和国家政策举措的重点，以改善器官移植的可及性。
