Deprived Neighborhoods and Disparities in Access to Living Donor Kidney Transplantation

The optimal treatment for patients with end-stage kidney disease (ESKD) is living donor kidney transplantation, which offers improved health outcomes. Deprived neighborhoods are defined as those with low socioeconomic status, limited social cohesion, and reduced access to health care. According to Byoungjum Kim and colleagues, there are few data available on the role of neighborhood deprivation in assess to living donor kidney transplantation.

The researchers conducted an analysis using data from the Scientific Registry of Transplant Recipients to identify 510,674 non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic kidney transplant candidates ≥18 years of age who were listed for a first kidney transplant from 1995 to 2021. Results were reported during a poster session at the American Society of Nephrology Kidney Week 2023 in a poster titled Neighborhood Deprivation and Access to Living Donor Kidney Transplantation: Reducing Health Care Disparities.

Using population weights from the American Community Survey, the National Cancer Institute’s Neighborhood Deprivation Index was averaged at the ZIP code level. The likelihood of living donor kidney transplant across tertiles was determined using proportional hazards models, adjusting for clinical and neighborhood-level factors.

Results of the analysis revealed that candidates for living donor kidney transplant who resided in high-deprivation neighborhoods had a lower access to living donor kidney transplantation compared with those in low-deprivation neighborhoods (adjusted hazard ratio [aHR], 0.80; 95% CI, 0.79-0.82). Black candidates residing in high-deprivation neighborhoods had 37% lower access to living donor kidney transplantation compared with candidates in low-deprivation neighborhoods (aHR, 0.63; 95% CI, 0.60-0.67). Asian and Hispanic candidates living in high-deprivation neighborhoods had 22% (aHR, 0.778; 95% CI, 0.70-0.88) and 21% (aHR, 0.79; 95% CI, 0.75-0.83), respectively, lower access to living donor kidney transplantation compared with White candidates.

“Neighborhood deprivation is associated with decreased access to living donor kidney transplantation, particularly among Black candidates. Identification of structural factors impacting health care access in disadvantaged neighborhoods can be used by policymakers and health care providers to develop interventions to address barriers and disparities in living donor kidney transplantation access,” the researchers said.

Source: Kim B, Menon G, Li Y, et al. Neighborhood deprivation and access to living donor kidney transplantation: reducing health care disparities. TH-PO881. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania.