Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
J Surg Res. 2024 Nov;303:189-198. doi: 10.1016/j.jss.2024.09.012. Epub 2024 Oct 4.
The Social Vulnerability Index (SVI) is a tool that was developed by the Centers for Disease Control and Prevention to help identify communities that are at risk of harm from social, economic, or environmental factors. This study evaluates the association between SVI and outcomes of adult heart transplantation (HT) in the United States.
The United Network for Organ Sharing registry was used to identify all isolated adult (≥18 y) HT recipients and their home address zip codes between 2010 and 2021. Recipients were classified into three SVI risk groups: low risk (SVI: <0.33), intermediate risk (SVI: 0.33-0.65), and high risk (SVI: ≥0.66). Kaplan-Meier analysis was used to estimate recipient survival probability based on SVI risk. Multivariable Cox proportional hazard models were built to evaluate the association of SVI with 1- and 5-y mortality.
A total of 22,400 recipients distributed over 9753 zip codes were included. Unadjusted 1-y survival rates in the three risk groups were as follows: low risk: 90.5%, intermediate risk: 91.1%, high risk 90.9%, and Log-rank P = 0.550 and 5-y survival rates were as follows: low risk: 80.8%, intermediate risk: 78.6%, high risk: 76.1%, and Log-rank P < 0.001. Compared to low-risk recipients, risk-adjusted 1-y mortality hazard ratio was 1.02 (0.92-1.14, P = 0.657) for intermediate risk and 1.09 (0.95-1.24, P = 0.222) for high-risk recipients. Risk-adjusted 5-y mortality hazard ratio was 1.07 (0.99-1.16, P = 0.095) for intermediate-risk recipients and 1.17 (1.06-1.28, P = 0.002) for high-risk recipients.
Social vulnerability is associated with HT outcomes. The Centers for Disease Control and Prevention SVI may be a useful tool in identifying at-risk geographic areas where targeted efforts may be prudent for reducing disparities in HT outcomes.
社会脆弱性指数（SVI）是疾病控制与预防中心开发的一种工具，用于帮助识别面临社会、经济或环境因素伤害风险的社区。本研究评估了 SVI 与美国成人心脏移植（HT）结果之间的关联。
使用器官共享联合网络注册中心确定了 2010 年至 2021 年间所有孤立的成人（≥18 岁）HT 受者及其家庭住址邮政编码。将受者分为三个 SVI 风险组：低风险（SVI：<0.33）、中风险（SVI：0.33-0.65）和高风险（SVI：≥0.66）。Kaplan-Meier 分析用于根据 SVI 风险估计受者的生存概率。建立多变量 Cox 比例风险模型以评估 SVI 与 1 年和 5 年死亡率的关系。
共纳入 22400 名受者，分布在 9753 个邮政编码中。三组风险患者的 1 年未调整生存率分别为：低风险组：90.5%，中风险组：91.1%，高风险组：90.9%，Log-rank P=0.550，5 年生存率分别为：低风险组：80.8%，中风险组：78.6%，高风险组：76.1%，Log-rank P<0.001。与低风险组受者相比，1 年风险调整死亡率的风险比为 1.02（92-1.14，P=0.657），中风险组为 1.09（95-1.24，P=0.222），高风险组为 1.09（95-1.24，P=0.222）。高风险组风险调整 5 年死亡率的风险比为 1.07（99-1.16，P=0.095），高风险组为 1.17（1.06-1.28，P=0.002）。
社会脆弱性与 HT 结果相关。疾病预防控制中心的 SVI 可能是一种有用的工具，可以识别面临风险的地理区域，在这些区域，有针对性的努力可能有助于减少 HT 结果的差异。
