The Association of Community Health Indicators With Outcomes for Kidney Transplant Recipients in the United States

OBJECTIVE To evaluate the association of community health indicators with outcomes for kidney transplant recipients. DESIGN Retrospective observational cohort study using multivariable Cox proportional hazards models. SETTING Transplant recipients in the United States from the Scientific Registry of Transplant Recipients merged with health indicators compiled from several national databases and the Centers for Disease Control and Prevention, including the National Center for Health Statistics, the Behavioral Risk Factor Surveillance System, and the National Center for Chronic Disease Prevention and Health Promotion. PATIENTS A total of 100 164 living and deceased donor adult (aged ≥18 years) kidney transplant recipients who underwent a transplant between January 1, 2004, and December 31, 2010. MAIN OUTCOME MEASURES Risk-adjusted time to posttransplant mortality and graft loss. RESULTS Multiple health indicators from recipients' residence were independently associated with outcomes, including low birth weight, preventable hospitalizations, inactivity rate, and smoking and obesity prevalence. Recipients in the highest-risk counties were more likely to be African American (adjusted odds ratio, 1.59, 95% CI, 1.51-1.68), to be younger (aged 18-39 years; 1.46; 1.32-1.60), to have lower educational attainment (