Social Determinants of Health Impact Successful Listing for Liver and Kidney Transplant
Duke University, Durham, NC
Meeting: 2022 American Transplant Congress
Abstract number: 69
Keywords: Kidney transplantation, Liver transplantation, Waiting lists
Topic: Clinical Science » Organ Inclusive » 70 - Non-Organ Specific: Disparities to Outcome and Access to Healthcare
Session Information
Session Name: Disparities to Outcome and Access to Healthcare
Session Type: Rapid Fire Oral Abstract
Date: Sunday, June 5, 2022
Session Time: 3:30pm-5:00pm
Presentation Time: 3:40pm-3:50pm
Location: Hynes Room 311
*Purpose: To evaluate the association between community socioeconomic disadvantage and structural social determinants of health (SDOH) on successful listing for liver (LT) and kidney transplantation (KT).
*Methods: Home addresses of adults referred to our center for LT and KT from North Carolina and adjacent states from 2016-2019 were geoprocessed. Neighborhood-level socioeconomic disadvantage was measured using the Area of Deprivation Index (ADI). Structural SDOH were based on the PhenX toolkit and included measures of poverty, community educational attainment, environmental justice, social vulnerability index (SVI), and food swamps. Block group demographics were also obtained. These measures were compared by listing status after referral. We also examined correlation with time from referral to listing.
*Results: A total of 1500 adults were referred for LT, 26.9% (403) of whom were listed, and 4329 were referred for KT, of whom 23.3% (1008) were listed. Adults living in areas with greater community deprivation, higher poverty, lower educational attainment, and higher SVI were less likely to be listed for LT and KT (Table; Figure). All environmental justice indexes also differed by listing status for both LT and KT, while the presence of food swamps was similar. Among listed individuals, ADI correlated with time to listing for LT (r=0.11, p=0.03) and KT (r=0.16, p=0.001). Time to KT listing was additionally associated with SVI (r=0.12, p=0.001), community poverty level (r=0.13, p=0.001), and college education (r=-0.13, p=0.001). Overall 23.2% (348) of individuals referred for LT and 47.7% (2066) for KT were from majority non-white areas. Individuals who lived in these areas were less likely to be listed (LT: 21.0% vs. 28.6%, p=0.005; KT: 19.8% vs. 26.6%, p=0.001).
*Conclusions: Individuals from areas of greater socioeconomic deprivation, poverty, lower educational attainment, social vulnerability, and environmental vulnerability experience barriers in successfully accessing the LT and KT waiting lists after referral and greater time to listing and are more likely to live in minority-predominant neighborhoods. Center-driven interventions targeting structural SDOH are needed to promote equity in access to abdominal transplant.
| Liver – Listed | Liver – Not Listed | p-value | Kidney- Listed | Kidney – Not Listed | p-value | |
| Mean ADI percentile (±SD) | 54.9 (±23.3) | 58.3 (±22.7) | 0.01 | 57.6 (±23.8) | 64.8 (±23.1) | 0.001 |
| Mean SVI percentile (±SD) | 49.7 (±27.2) | 52.8 (±26.2) | 0.04 | 54.7 (±28.0) | 63.5 (±27.0) | 0.001 |
| Median % under poverty level (IQR) | 9.8 (4.6-18.8) | 11.7 (5.8-19.8) | 0.01 | 11.1 (5.0-20.0) | 14.7 (7.5-25.3) | 0.001 |
| Median % college degree (IQR) | 25.1 (14.7-43.8) | 23.4 (14.2-38.9) | 0.04 | 28.0 (15.5-43.4) | 22.1 (13.1-36.3) | 0.001 |
To cite this abstract in AMA style:
Henson JB, Mohottige D, Wilder JM, Muir AJ, McElroy LM. Social Determinants of Health Impact Successful Listing for Liver and Kidney Transplant [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/social-determinants-of-health-impact-successful-listing-for-liver-and-kidney-transplant/. Accessed June 19, 2025.« Back to 2022 American Transplant Congress