Impact of Community Socioeconomic Distress on Survival Following Heart Transplantation

Abstract

Objective: The aim of this study was to assess the impact of community-level socioeconomic deprivation on survival outcomes following heart transplantation. Background: Despite growing awareness of socioeconomic disparities in the US health care system, significant inequities in outcomes remain. While recent literature has increasingly considered the effects of structural socioeconomic deprivation, the impact of community socioeconomic distress on outcomes following heart transplantation has not yet been elucidated. Methods: All adult heart transplant recipients from 2004 to 2022 were ascertained from the Organ Procurement and Transplantation Network. Community socioeconomic distress was assessed using the previously validated Distressed Communities Index, a metric that represents education level, housing vacancies, unemployment, poverty rate, median household income, and business growth by zip code. Communities in the highest quintile were considered the Distressed cohort (others: Non-Distressed). Outcomes were considered across 2 eras (2004–2018 and 2019–2022) to account for the 2018 UNOS Policy Change. Three- and 5-year patient and graft survival were assessed using Kaplan-Meier and Cox proportional hazards models. Results: Of 36,777 heart transplants, 7450 (20%) were considered distressed. Following adjustment, distressed recipients demonstrated a greater hazard of 5-year mortality from 2004 to 2018 [hazard ratio (HR)=1.10, 95% confidence interval (CI): 1.03–1.18; P=0.005] and 3-year mortality from 2019 to 2022 (HR=1.29, 95% CI: 1.10–1.51; P=0.002), relative to nondistressed. Similarly, the distressed group was associated with increased hazard of graft failure at 5 years from 2004 to 2018 (HR=1.10, 95% CI: 1.03–1.18; P=0.003) and at 3 years from 2019 to 2022 (HR=1.31, 95% CI: 1.11–1.53; P=0.001). Conclusions: Community-level socioeconomic deprivation is linked with inferior patient and graft survival following heart transplantation. Future interventions are needed to address pervasive socioeconomic inequities in transplantation outcomes.