A Fresh Look at Urbanicity and Its Impact on Additions to the Kidney and Liver Transplant Wait Lists
General Surgery, Vanderbilt University Medical Center, Nashville, TN
Meeting: 2021 American Transplant Congress
Abstract number: 309
Keywords: Kidney/liver transplantation, Multivariate analysis, Public policy, Waiting lists
Topic: Clinical Science » Organ Inclusive » Non-Organ Specific: Disparities to Outcome and Access to Healthcare
Session Information
Session Name: Disparities in Access and Machine Learning Outcomes in Solid Organ Transplantation
Session Type: Rapid Fire Oral Abstract
Date: Tuesday, June 8, 2021
Session Time: 4:30pm-5:30pm
Presentation Time: 4:30pm-4:35pm
Location: Virtual
*Purpose: Our aim is to examine the collective effects of social determinants of health (SDH) on kidney and liver wait list additions in the United States.
*Methods: Principal components analysis of 127 county-level socioeconomic (SE) and health-related (HR) variables from publicly available American Community Survey, Robert Wood Johnson County Health Rankings, and Institute for Health Metrics and Evaluation datasets was used to identify two SDH composites. Population-weighted composite scores were computed for 50 states and the District of Columbia (analysis N=51). 53,004 adult kidney and 21,701 adult liver waitlist additions in 2017-2018 and listing center density (population-adjusted number of centers per state) were determined using Scientific Registry of Transplant Recipients data. End-stage renal disease incidence and potentially transplantable liver mortality were determined using United States Renal Data System and National Center for Health Statistics data. Multiple linear regression models evaluated the effects of composite scores, listing center density, and whether Medicaid expansion was accepted on disease- and population-adjusted numbers of kidney and liver transplant wait list additions.
*Results: Two SDH composites were identified: 1) SE/HR and 2) urbanicity. After adjusting for listing center density and Medicaid expansion (all p>0.12), state-level kidney and liver transplant disease- and population-adjusted wait list additions were significantly associated with urbanicity (both p<0.05) and not with the SE/HR composite [Table 1].
*Conclusions: Listing for kidney and liver transplant in the United States is independently associated with urbanicity; the collective impact of SE/HR was not independently associated with wait list additions in this study. Policy and quality improvement initiatives should be directed towards bridging the gap in wait list access between urban and rural populations. Furthermore, consideration should be given to investigating the collective effects of SDH on all transplant milestones.
To cite this abstract in AMA style:
Johnson WR, Rega SA, Feurer ID, Karp SJ. A Fresh Look at Urbanicity and Its Impact on Additions to the Kidney and Liver Transplant Wait Lists [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/a-fresh-look-at-urbanicity-and-its-impact-on-additions-to-the-kidney-and-liver-transplant-wait-lists/. Accessed May 16, 2025.« Back to 2021 American Transplant Congress