Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients
BACKGROUNDSocioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation. The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of stud...
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| Veröffentlicht in: | Transplantation 2016-07, Vol.100 (7), p.1550-1557 |
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| creator | Taber, David J Hamedi, Mahsa Rodrigue, James R Gebregziabher, Mulugeta G Srinivas, Titte R Baliga, Prabhakar K Egede, Leonard E |
| description | BACKGROUNDSocioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation. The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of studies analyzing this measure longitudinally or between races.
METHODSLongitudinal cohort study in adult kidney transplantation transplanted at a single-center between 2005 and 2012. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a minimum of 0 and maximum of 3 for an aggregate of 0 to 15 (higher score → better SES).
RESULTSOne thousand one hundred seventy-one patients were included; 624 (53%) were African American (AA) and 547 were non-AA. African Americans had significantly lower mean baseline SAI scores (AAs 6.5 vs non-AAs 7.8; P < 0.001). Cox regression analysis demonstrated that there was no association between baseline SAI and acute rejection in non-AAs (hazard ratio [HR], 0.92; 95% confidence interval [95% CI], 0.81-1.05), whereas it was a significant predictor of acute rejection in AAs (HR, 0.89; 95% CI, 0.80-0.99). Similarly, a 2-stage approach to joint modelling of time to graft loss and longitudinal SAI did not predict graft loss in non-AAs (HR, 1.01; 95% CI, 0.28-3.62), whereas it was a significant predictor of graft loss in AAs (HR, 0.23; 95% CI, 0.06-0.93).
CONCLUSIONSAfter controlling for confounders, SAI scores were associated with a lower risk of acute rejection and graft loss in AA kidney transplant recipients, whereas neither baseline nor follow-up SAI predicted outcomes in non-AA kidney transplant recipients. |
| doi_str_mv | 10.1097/TP.0000000000000931 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4818195</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1799213389</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4531-33906caf9fb2b2f605fa3c5d20902156e79388a7c750fb71e91f6dd79c6dd2ab3</originalsourceid><addsrcrecordid>eNp9kU1vFSEUhonR2NvqLzAxLN1MhWEYho2JabRtbNKv65owzKGXOgMjMG3uvy_m1qa6KAtI4DnPAV6EPlBySIkUn9cXh-T5kIy-QivKWVO1pCOv0YqQhlaUMbGH9lO6LQxnQrxFe3Xb1LwTfIVuLxfts7Nb529w3gC-0gbwdY66bDoY8Ok0a5NxsPg6GBfABB8mZxIOHh9HbTM-X7IJEyTsPP7hBg9bvI7ap3ksZnwFxs0OfE7v0BurxwTvH9cD9PP7t_XRSXV2fnx69PWsMg1ntGJMktZoK21f97VtCbeaGT7URJKa8haEZF2nhRGc2F5QkNS2wyCkKXOte3aAvuy889JPMJjSO-pRzdFNOm5V0E79e-LdRt2EO9V0tKOSF8GnR0EMvxdIWU0uGRjLeyAsSVEhZV2-tZMFZTvUxJBSBPvUhhL1JyW1vlD_p1SqPj6_4VPN31gKIHbAfRgzxPRrXO4hqg3oMW9eVD8AKSKgUg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1799213389</pqid></control><display><type>article</type><title>Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Taber, David J ; Hamedi, Mahsa ; Rodrigue, James R ; Gebregziabher, Mulugeta G ; Srinivas, Titte R ; Baliga, Prabhakar K ; Egede, Leonard E</creator><creatorcontrib>Taber, David J ; Hamedi, Mahsa ; Rodrigue, James R ; Gebregziabher, Mulugeta G ; Srinivas, Titte R ; Baliga, Prabhakar K ; Egede, Leonard E</creatorcontrib><description>BACKGROUNDSocioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation. The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of studies analyzing this measure longitudinally or between races.
METHODSLongitudinal cohort study in adult kidney transplantation transplanted at a single-center between 2005 and 2012. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a minimum of 0 and maximum of 3 for an aggregate of 0 to 15 (higher score → better SES).
RESULTSOne thousand one hundred seventy-one patients were included; 624 (53%) were African American (AA) and 547 were non-AA. African Americans had significantly lower mean baseline SAI scores (AAs 6.5 vs non-AAs 7.8; P < 0.001). Cox regression analysis demonstrated that there was no association between baseline SAI and acute rejection in non-AAs (hazard ratio [HR], 0.92; 95% confidence interval [95% CI], 0.81-1.05), whereas it was a significant predictor of acute rejection in AAs (HR, 0.89; 95% CI, 0.80-0.99). Similarly, a 2-stage approach to joint modelling of time to graft loss and longitudinal SAI did not predict graft loss in non-AAs (HR, 1.01; 95% CI, 0.28-3.62), whereas it was a significant predictor of graft loss in AAs (HR, 0.23; 95% CI, 0.06-0.93).
CONCLUSIONSAfter controlling for confounders, SAI scores were associated with a lower risk of acute rejection and graft loss in AA kidney transplant recipients, whereas neither baseline nor follow-up SAI predicted outcomes in non-AA kidney transplant recipients.</description><identifier>ISSN: 0041-1337</identifier><identifier>EISSN: 1534-6080</identifier><identifier>DOI: 10.1097/TP.0000000000000931</identifier><identifier>PMID: 26425875</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; African Americans ; Aged ; Employment ; Female ; Follow-Up Studies ; Graft Rejection - etiology ; Graft Survival ; Humans ; Immunosuppressive Agents - therapeutic use ; Kidney Transplantation ; Longitudinal Studies ; Male ; Middle Aged ; Multivariate Analysis ; Renal Insufficiency - economics ; Renal Insufficiency - ethnology ; Renal Insufficiency - surgery ; Retrospective Studies ; Social Class ; Transplant Recipients ; Treatment Outcome</subject><ispartof>Transplantation, 2016-07, Vol.100 (7), p.1550-1557</ispartof><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4531-33906caf9fb2b2f605fa3c5d20902156e79388a7c750fb71e91f6dd79c6dd2ab3</citedby><cites>FETCH-LOGICAL-c4531-33906caf9fb2b2f605fa3c5d20902156e79388a7c750fb71e91f6dd79c6dd2ab3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26425875$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Taber, David J</creatorcontrib><creatorcontrib>Hamedi, Mahsa</creatorcontrib><creatorcontrib>Rodrigue, James R</creatorcontrib><creatorcontrib>Gebregziabher, Mulugeta G</creatorcontrib><creatorcontrib>Srinivas, Titte R</creatorcontrib><creatorcontrib>Baliga, Prabhakar K</creatorcontrib><creatorcontrib>Egede, Leonard E</creatorcontrib><title>Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description>BACKGROUNDSocioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation. The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of studies analyzing this measure longitudinally or between races.
METHODSLongitudinal cohort study in adult kidney transplantation transplanted at a single-center between 2005 and 2012. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a minimum of 0 and maximum of 3 for an aggregate of 0 to 15 (higher score → better SES).
RESULTSOne thousand one hundred seventy-one patients were included; 624 (53%) were African American (AA) and 547 were non-AA. African Americans had significantly lower mean baseline SAI scores (AAs 6.5 vs non-AAs 7.8; P < 0.001). Cox regression analysis demonstrated that there was no association between baseline SAI and acute rejection in non-AAs (hazard ratio [HR], 0.92; 95% confidence interval [95% CI], 0.81-1.05), whereas it was a significant predictor of acute rejection in AAs (HR, 0.89; 95% CI, 0.80-0.99). Similarly, a 2-stage approach to joint modelling of time to graft loss and longitudinal SAI did not predict graft loss in non-AAs (HR, 1.01; 95% CI, 0.28-3.62), whereas it was a significant predictor of graft loss in AAs (HR, 0.23; 95% CI, 0.06-0.93).
CONCLUSIONSAfter controlling for confounders, SAI scores were associated with a lower risk of acute rejection and graft loss in AA kidney transplant recipients, whereas neither baseline nor follow-up SAI predicted outcomes in non-AA kidney transplant recipients.</description><subject>Adult</subject><subject>African Americans</subject><subject>Aged</subject><subject>Employment</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft Rejection - etiology</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kidney Transplantation</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Renal Insufficiency - economics</subject><subject>Renal Insufficiency - ethnology</subject><subject>Renal Insufficiency - surgery</subject><subject>Retrospective Studies</subject><subject>Social Class</subject><subject>Transplant Recipients</subject><subject>Treatment Outcome</subject><issn>0041-1337</issn><issn>1534-6080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1vFSEUhonR2NvqLzAxLN1MhWEYho2JabRtbNKv65owzKGXOgMjMG3uvy_m1qa6KAtI4DnPAV6EPlBySIkUn9cXh-T5kIy-QivKWVO1pCOv0YqQhlaUMbGH9lO6LQxnQrxFe3Xb1LwTfIVuLxfts7Nb529w3gC-0gbwdY66bDoY8Ok0a5NxsPg6GBfABB8mZxIOHh9HbTM-X7IJEyTsPP7hBg9bvI7ap3ksZnwFxs0OfE7v0BurxwTvH9cD9PP7t_XRSXV2fnx69PWsMg1ntGJMktZoK21f97VtCbeaGT7URJKa8haEZF2nhRGc2F5QkNS2wyCkKXOte3aAvuy889JPMJjSO-pRzdFNOm5V0E79e-LdRt2EO9V0tKOSF8GnR0EMvxdIWU0uGRjLeyAsSVEhZV2-tZMFZTvUxJBSBPvUhhL1JyW1vlD_p1SqPj6_4VPN31gKIHbAfRgzxPRrXO4hqg3oMW9eVD8AKSKgUg</recordid><startdate>201607</startdate><enddate>201607</enddate><creator>Taber, David J</creator><creator>Hamedi, Mahsa</creator><creator>Rodrigue, James R</creator><creator>Gebregziabher, Mulugeta G</creator><creator>Srinivas, Titte R</creator><creator>Baliga, Prabhakar K</creator><creator>Egede, Leonard E</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201607</creationdate><title>Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients</title><author>Taber, David J ; Hamedi, Mahsa ; Rodrigue, James R ; Gebregziabher, Mulugeta G ; Srinivas, Titte R ; Baliga, Prabhakar K ; Egede, Leonard E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4531-33906caf9fb2b2f605fa3c5d20902156e79388a7c750fb71e91f6dd79c6dd2ab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>African Americans</topic><topic>Aged</topic><topic>Employment</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft Rejection - etiology</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kidney Transplantation</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Renal Insufficiency - economics</topic><topic>Renal Insufficiency - ethnology</topic><topic>Renal Insufficiency - surgery</topic><topic>Retrospective Studies</topic><topic>Social Class</topic><topic>Transplant Recipients</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Taber, David J</creatorcontrib><creatorcontrib>Hamedi, Mahsa</creatorcontrib><creatorcontrib>Rodrigue, James R</creatorcontrib><creatorcontrib>Gebregziabher, Mulugeta G</creatorcontrib><creatorcontrib>Srinivas, Titte R</creatorcontrib><creatorcontrib>Baliga, Prabhakar K</creatorcontrib><creatorcontrib>Egede, Leonard E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Taber, David J</au><au>Hamedi, Mahsa</au><au>Rodrigue, James R</au><au>Gebregziabher, Mulugeta G</au><au>Srinivas, Titte R</au><au>Baliga, Prabhakar K</au><au>Egede, Leonard E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>2016-07</date><risdate>2016</risdate><volume>100</volume><issue>7</issue><spage>1550</spage><epage>1557</epage><pages>1550-1557</pages><issn>0041-1337</issn><eissn>1534-6080</eissn><abstract>BACKGROUNDSocioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation. The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of studies analyzing this measure longitudinally or between races.
METHODSLongitudinal cohort study in adult kidney transplantation transplanted at a single-center between 2005 and 2012. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a minimum of 0 and maximum of 3 for an aggregate of 0 to 15 (higher score → better SES).
RESULTSOne thousand one hundred seventy-one patients were included; 624 (53%) were African American (AA) and 547 were non-AA. African Americans had significantly lower mean baseline SAI scores (AAs 6.5 vs non-AAs 7.8; P < 0.001). Cox regression analysis demonstrated that there was no association between baseline SAI and acute rejection in non-AAs (hazard ratio [HR], 0.92; 95% confidence interval [95% CI], 0.81-1.05), whereas it was a significant predictor of acute rejection in AAs (HR, 0.89; 95% CI, 0.80-0.99). Similarly, a 2-stage approach to joint modelling of time to graft loss and longitudinal SAI did not predict graft loss in non-AAs (HR, 1.01; 95% CI, 0.28-3.62), whereas it was a significant predictor of graft loss in AAs (HR, 0.23; 95% CI, 0.06-0.93).
CONCLUSIONSAfter controlling for confounders, SAI scores were associated with a lower risk of acute rejection and graft loss in AA kidney transplant recipients, whereas neither baseline nor follow-up SAI predicted outcomes in non-AA kidney transplant recipients.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>26425875</pmid><doi>10.1097/TP.0000000000000931</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult African Americans Aged Employment Female Follow-Up Studies Graft Rejection - etiology Graft Survival Humans Immunosuppressive Agents - therapeutic use Kidney Transplantation Longitudinal Studies Male Middle Aged Multivariate Analysis Renal Insufficiency - economics Renal Insufficiency - ethnology Renal Insufficiency - surgery Retrospective Studies Social Class Transplant Recipients Treatment Outcome |
| title | Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients |
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