Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA.
Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
Clin Transplant. 2024 Jul;38(7):e15382. doi: 10.1111/ctr.15382.
Adults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live-donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity.
We studied 403 937 adults (age ≥ 18) KT candidates (national transplant registry; 2006-2021). NDI and its 10 components were averaged at the ZIP-code level. Cause-specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components.
Candidates residing in high-deprivation neighborhoods were more likely to be female (40.1% vs. 36.2%) and Black (41.9% vs. 17.7%), and were less likely to receive both LDKT (aHR = 0.66, 95% confidence interval [CI]: 0.64-0.67) and preemptive KT (aHR = 0.60, 95% CI: 0.59-0.62) than those in low-deprivation neighborhoods. These associations differedby race and ethnicity (Black: aHR = 0.58, 95% CI: 0.55-0.62; aHR = 0.68, 95% CI: 0.63-0.73; P: LDKT < 0.001; Preemptive KT = 0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value): for example, higher median household income (LDKT: aHR = 1.08, 95% CI: 1.07-1.09; Preemptive KT: aHR = 1.10, 95% CI: 1.08-1.11) and educational attainments (≥high school [LDKT: aHR = 1.17, 95% CI: 1.15-1.18; Preemptive KT: aHR = 1.23, 95% CI: 1.21-1.25]).
Residence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood-level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.
居住在贫困社区的成年人面临着各种社会经济压力，这阻碍了他们接受活体供肾移植（LDKT）和抢先肾移植（KT）的可能性。我们量化了居住社区剥夺指数（NDI）与 LDKT/抢先 KT 可能性之间的关联，并测试了种族和民族差异的影响。
我们研究了 403937 名成年 KT 候选者（年龄≥18 岁）（国家移植登记处；2006-2021 年）。NDI 及其 10 个组成部分在邮政编码水平上进行平均。使用特定原因的风险比（aHR）模型来量化 NDI 及其 10 个组成部分的三分位数中 LDKT 和抢先 KT 的调整后的风险比（aHR）。
居住在高剥夺社区的候选人更可能是女性（40.1%对 36.2%）和黑人（41.9%对 17.7%），并且与居住在低剥夺社区的候选人相比，接受 LDKT（aHR=0.66，95%置信区间[CI]：0.64-0.67）和抢先 KT（aHR=0.60，95%CI：0.59-0.62）的可能性较小。这些关联因种族和民族而异（黑人：aHR=0.58，95%CI：0.55-0.62；aHR=0.68，95%CI：0.63-0.73；P：LDKT<0.001；抢先 KT=0.002）。所有剥夺组成部分都与 LDKT 和抢先 KT 的可能性相关（中位数家庭价值除外）：例如，更高的家庭中位收入（LDKT：aHR=1.08，95%CI：1.07-1.09；抢先 KT：aHR=1.10，95%CI：1.08-1.11）和教育程度（高中以上[LDKT：aHR=1.17，95%CI：1.15-1.18；抢先 KT：aHR=1.23，95%CI：1.21-1.25]）。
居住在社会经济上处于劣势的社区与 LDKT 和抢先 KT 的可能性降低有关，这对少数族裔候选人有不同的影响。确定并了解哪些邻里级别的社会经济地位导致了这些种族差异，有助于制定干预措施，以实现 LDKT 和抢先 KT 中的健康公平。
