ArticlePloS one2024
Individual-level social determinants of health and disparities in access to kidney transplant and waitlist mortality.
Article in PloS one, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Health insurance and kidney transplantation outcomes in the United States: a systematic review and AI-driven analysis of disparities in access and survival.Renal failure · 2025Pooled it
- Leveraging Natural Language Processing to Identify Variation in Kidney Transplant Access.Kidney international reports · 2026Article
- Structural Barriers Underlying Kidney and Liver Transplant Inequity in Hispanic Americans.Cureus · 2026Review
- Impact of obesity and income on the likelihood of kidney transplantation: A retrospective cohort study.World journal of transplantation · 2026Article
- Recipient Human Leukocyte Antigen-DR Homozygosity and Access to Quality Kidneys.Kidney international reports · 2026Article
- Influence of Individual- and Area-Level Social Determinants of Health on Likelihood of Living Versus Deceased Donor Kidney Transplantation.Kidney international reports · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundComprehensive, individual-level social determinants of health (SDOH) are not collected in national transplant registries, limiting research aimed at understanding the relationship between SDOH and waitlist outcomes among kidney transplant candidates.
methodsWe merged Organ Procurement and Transplantation Network data with individual-level SDOH data from LexisNexis, a commercial data vendor, and conducted a competing risk analysis to determine the association between individual-level SDOH and the cumulative incidence of living donor kidney transplant (LDKT), deceased donor kidney transplant (DDKT), and waitlist mortality. We included adult kidney transplant candidates placed on the waiting list in 2020, followed through December 2023.
resultsIn multivariable analysis, having public insurance (Medicare or Medicaid), less than a college degree, and any type of derogatory record (liens, history of eviction, bankruptcy and/ felonies) were associated with lower likelihood of LDKT. Compared with patients with estimated individual annual incomes ≤ $30,000, patients with incomes ≥ $120,000 were more likely to receive a LDKT (sub distribution hazard ratio (sHR), 2.52; 95% confidence interval (CI), 2.03-3.12). Being on Medicare (sHR, 1.49; 95% CI, 1.42-1.57), having some college or technical school, or at most a high school diploma were associated with a higher likelihood of DDKT. Compared with patients with incomes ≤ $30,000, patients with incomes ≥ $120,000 were less likely to receive a DDKT (sHR, 0.60; 95% CI, 0.51-0.71). Lower individual annual income, having public insurance, at most a high school diploma, and a record of liens or eviction were associated with higher waitlist mortality.
conclusionsPatients with adverse individual-level SDOH were less likely to receive LDKT, more likely to receive DDKT, and had higher risk of waitlist mortality. Differential relationships between SDOH, access to LDKT, DDKT, and waitlist mortality suggest the need for targeted interventions aimed at decreasing waitlist mortality and increasing access to LDKT among patients with adverse SDOH.
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