Compared to those from non-distressed communities, patients from socioeconomically disadvantaged communities had a 10% higher relative risk of graft failure and death within five years after receiving a heart transplant. This study was led by Sara Sakowitz, a medical student at the David Geffen School of Medicine at UCLA().
Analyzing Socio-economic Disparities in Heart Transplant Outcome
Following the implementation of the 2018 UNOS Heart Allocation policy, transplant recipients between 2018 and 2022 faced an approximately 20% increase in relative risk of dying or experiencing graft failure within three years compared with the pre-policy period. This is despite the fact that the proportion of distressed patients remained the same over both eras.
Significant socioeconomic disparities persist within the U.S. healthcare system. While previous studies have demonstrated the influence of structural deprivation on cardiovascular health, the impact of community distress on survival following heart transplantation has not been explored.
The researchers relied on 2004-2022 data from the Organ Procurement and Transplantation Network (OPTN) to ascertain the number of adult heart transplant patients, and the Distressed Communities Index (DCI), which uses neighborhood factors such as unemployment, poverty level, median income and housing vacancies
to measure community socioeconomic inequity. Of 36,777 heart transplant patients, 7,450 were from distressed communities.
Study limitations include a lack of granular data such as laboratory values and operative times, unavailability of patient medication adherence for analysis, and an inability to identify transplant centersï¿½ location or proximity to socioeconomically distressed communities.
Addressing Social Inequity Gap for Better Survival Rates Post Heart Transplantation
Structural community distress is linked with inferior survival following heart transplantation, with the disparity gap in outcomes widening since the 2018 Policy Change.
Further, the DCI should be integrated into risk-stratification models to prevent risk-averse transplantation strategies that would disproportionately affect under-served patients. Given the compounding ramifications of the COVID-19 pandemic, particularly on already vulnerable populations, the field of heart transplantation must directly confront expanding inequity in outcomes.
"While social determinants of health have long been recognized to both shape access to and outcomes following heart transplantation, lack of clear metrics to measure such inequity has limited the development of targeted interventions,ï¿½ said Sara Sakowitz, a medical student at the David Geffen School of Medicine at UCLA who led the study.
ï¿½Our work demonstrates community-level socioeconomic distress is linked with inferior survival following heart transplantation, and further establishes this socioeconomic disparity gap is widening. Changes in policy are needed to address persistent inequities in access to health,ï¿½ he said.
- Impact of Community Socioeconomic Distress on Survival Following Heart Transplantation - (https:journals.lww.com/annalsofsurgery/abstract/9900/impact_of_community_socioeconomic_distress_on.635.aspx)