Exploring Caregiver Support as a Potential Mediator of Neighborhood Socioeconomic Disadvantage and Reduced Likelihood of Liver Transplant Waitlisting.

Background: Individuals from socioeconomically disadvantaged neighborhoods may be at risk of inequitable access to the liver transplant (LT) waitlisting (WL), but mechanisms mediating this relationship are not well understood. We assessed whether area deprivation index (ADI), a measure of neighborhood socioeconomic deprivation, was associated with LT WL and assessed whether caregiver support, a potentially modifiable factor, mediated this relationship. Methods: We performed a single-center retrospective cohort study of adults referred for LT evaluation from January 2015 to December 2021. First, we assessed the association between ADI and LT WL using univariate and multivariable logistic regression analyses. Second, we analyzed caregiver support as a potential mediator through mediation analysis. Results: During the study period, 2574 patients were referred for LT, 2057 patients initiated evaluation, and 622 patients were waitlisted. Residence in the highest ADI quartile was associated with lower probability of WL (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.52-0.99) after adjusting for individual medical and sociodemographic factors, and distance from the transplant center. In adjusted mediation analysis, caregiver support did not mediate the relationship between ADI and LT WL (OR, 0.90; 95% CI, 0.80-1.01), and highest ADI quartile also did not have significant direct effects on LT WL (OR, 0.95; 95% CI, 0.72-1.26). Conclusions: ADI may be useful as a screening tool to identify candidates who could benefit from early intervention in the LT process when individual social needs information is not available. Caregiver support did not mediate the ADI and LT WL association. Additional work is needed to understand which modifiable factors may mediate this association to inform potential interventions for this population.