Brandon William M, Jacob Alan, Dunn Colin, Zhang Song, Gao Ang, Torres Fernando, Lawrence Adrian, Timofte Irina, Bollineni Srinivas, Mohanka Manish, Deleija-Lujano Juan, Khan Adnan, Crossno Joseph, Wait Michael, Peltz Matthias, Heid Christopher, Huffman Lynn, Ring Steve, Murala John, Keshavamurthy Suresh, Weston Alex Jaye, Kaza Vaidehi
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA.
Clin Transplant. 2025 Aug;39(8):e70289. doi: 10.1111/ctr.70289.
Access to transplantation is not entirely equitable with several studies demonstrating racial and socioeconomic disparities affecting the transplant process and thereby outcomes. Notably, few studies have focused on disparities prior to waitlisting. This study aimed to characterize the impact of community socioeconomic factors as measured by the Distressed Community Index (DCI) on acceptance for lung transplant waitlisting.
A retrospective review was performed on 463 patients evaluated for lung transplant waitlisting at our institution between 2016 and 2020. Community distress was calculated using the DCI, which yields a composite Distress Index (cDI) and includes data on various community characteristics. Statistical analysis was done using descriptive statistics and logistic regression methods.
Of the 463 patients included, 333 (71.9%) were accepted and 130 (28.1%) were denied for waitlisting. The mean cDI was 42.5 (±30.0) and 44.8 (±30.8) (p = 0.45) for the accepted and declined groups, respectively, indicating mid-tier distress for both groups by DCI metrics. The cDI was not found to be associated with odds of waitlist acceptance (OR 0.997, CI 0.99-1.004, p = 0.455). Furthermore, there was no association between sex, race, ethnicity, public insurance coverage, or any of the subcomponents of the DCI and the odds of successful waitlisting at our institution.
This single-center retrospective evaluation found that cDI, as calculated by the DCI, and the DCI subcomponents were not associated with transplant waitlist acceptance. Future studies should be done evaluating community-level socioeconomic disparities and the utility of community disadvantage indexing tools in the lung transplant waitlisting process, with the intentions of conceptually expanding our understanding of the link between transplant outcomes and biopsychosocial candidacy.
移植机会并不完全公平，多项研究表明种族和社会经济差异会影响移植过程，进而影响移植结果。值得注意的是，很少有研究关注列入候补名单之前的差异。本研究旨在描述以困境社区指数（DCI）衡量的社区社会经济因素对肺移植候补名单接受情况的影响。
对2016年至2020年期间在我们机构接受肺移植候补名单评估的463例患者进行回顾性研究。使用DCI计算社区困境程度，该指数产生一个综合困境指数（cDI），并包括各种社区特征的数据。采用描述性统计和逻辑回归方法进行统计分析。
在纳入的463例患者中，333例（71.9%）被接受列入候补名单，130例（28.1%）被拒绝。接受组和拒绝组的平均cDI分别为42.5（±30.0）和44.8（±30.8）（p = 0.45），根据DCI指标，两组均处于中等困境水平。未发现cDI与列入候补名单的几率相关（比值比0.997，可信区间0.99 - 1.004，p = 0.455）。此外，在我们机构，性别、种族、民族、公共保险覆盖情况或DCI的任何子成分与成功列入候补名单的几率之间均无关联。
这项单中心回顾性评估发现，由DCI计算得出的cDI及其子成分与移植候补名单的接受情况无关。未来应开展研究，评估社区层面的社会经济差异以及社区劣势指数工具在肺移植候补名单过程中的效用，以期从概念上扩展我们对移植结果与生物心理社会候选资格之间联系的理解。
