INTRODUCTION: Ensuring fair and equitable access to kidney transplantation (ATT) is of paramount importance. Socioeconomic disadvantage is associated with worse access to healthcare. Understanding the effects of socioeconomic disadvantage may be beneficial in designing interventions to improve ATT in kidney transplantation.

METHODS: The United States Renal Data System was queried for adult incident dialysis registrations in 2008; follow-up was through June 2013. Patients were matched by ZIP codes at registration to the Area Deprivation Index (ADI), a measure of neighborhood socioeconomic disadvantage. ATT was defined as enrolling on the kidney waitlist or receiving a living donor kidney transplant. Hierarchical multivariable logistic regression models, adjusted for comorbidities and clustered at the level of the Organ Procurement Organization (OPO), were created for the outcome of ATT.

RESULTS: 104,789 adults began dialysis in 2008. After adjusting for comorbidities, each ADI decile was strongly associated with a decreased odds of ATT compared to the least deprived ADI decile (Figure). Additional factors associated with a lower likelihood of ATT were female sex (OR 0.88, P < 0.001), not being under the care of a nephrologist at time of dialysis initiation (OR 0.41, P < 0.001), Black race (OR 0.83, P < 0.001), and Medicaid as primary insurance (OR 0.85, P < 0.001).

CONCLUSIONS: Even after adjusting for patient characteristics such as sex, race/ethnicity, insurance status, and local OPO transplant patterns, neighborhood socioeconomic disadvantage (as measured by the ADI) was strongly associated with a lower likelihood of ATT. The ADI could be used as a screening mechanism for identifying candidates at risk, and targeted efforts could be made to improve ATT for these patients.

CITATION INFORMATION: Adler J, Markmann J, Chang D, Yeh H. Neighborhood Socioeconomic Characteristics Influence Access to Kidney Transplantation Independently of Individual Socioeconomic Status. Am J Transplant. 2016;16 (suppl 3).

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