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County socioeconomic characteristics and pediatric renal transplantation outcomes

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Abstract

Background

Existing risk adjustment models for solid organ transplantation omit socioeconomic status (SES). With limited data available on transplant candidates’ SES, linkage of transplant outcomes data to geographic SES measures has been proposed. We investigate the utility of county SES for understanding differences in pediatric kidney transplantation (KTx) outcomes.

Methods

We identified patients < 18 years of age receiving first-time KTx using United Network for Organ Sharing registry data in two eras: 2006–2010 and 2011–2015, corresponding to periods of county SES data collection. In each era, counties were ranked by 1-year rates of survival with intact graft, and by county SES score. We used Spearman correlation (ρ) to evaluate the association between county rankings on SES and transplant outcomes in each era and consistency between these measures across eras. We also evaluated the utility of county SES for improving prediction of individual KTx outcomes.

Results

The analysis included 2972 children and 108 counties. County SES and transplant outcomes were not correlated in either 2006–2010 (ρ = 0.06; p = 0.525) or 2011–2015 (ρ = 0.162, p = 0.093). County SES rankings were strongly correlated between eras (ρ = 0.99, p < 0.001), whereas county rankings of transplant outcomes were not correlated between eras (ρ = 0.16, p = 0.097). Including county SES quintile in individual-level models of transplant outcomes did not improve model predictive utility.

Conclusions

Pediatric kidney transplant outcomes are unstable from period to period at the county level and are not correlated with county-level SES. Appropriate adjustment for SES disparities in transplant outcomes could require further collection of detailed individual SES data.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Rebecca Miller, Dmitry Tumin & Joseph D. Tobias

  2. Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA

    Clifford Akateh & Sylvester M. Black

  3. Center for Innovation in Pediatric Practice, Nationwide Children’s Hospital, Columbus, OH, USA

    Noelle Thompson

  4. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Dmitry Tumin

  5. Section of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, OH, USA

    Don Hayes Jr.

  6. Department of Pulmonary and Critical Care, The Ohio State University College of Medicine, Columbus, OH, USA

    Don Hayes Jr.

  7. Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    Joseph D. Tobias

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  1. Rebecca Miller
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Correspondence to Rebecca Miller.

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The authors declare that they have no conflict of interest.

Disclaimer

The data reported here have been supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network (OPTN). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the US Government.

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Miller, R., Akateh, C., Thompson, N. et al. County socioeconomic characteristics and pediatric renal transplantation outcomes. Pediatr Nephrol 33, 1227–1234 (2018). https://doi.org/10.1007/s00467-018-3928-0

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