Lower socioeconomic status is associated with worse outcomes after both listing and transplanting children with heart failure

Ryan R Davies, Mark J. Russo, Olaf Reinhartz, Katsuhide Maeda, David N. Rosenthal, Clifford Chin, Daniel Bernstein, Hari R. Mallidi

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

The relationship between SES and outcomes surrounding pediatric cardiac transplantation is complex and influenced by recipient race. Broad-based studies of SES have not been performed. A retrospective review of all 5125 primary pediatric heart transplants performed in the United States between 2000 and 2011. Patients were stratified by SES based on zip code of residence and U.S. census data (low SES: 1637; mid-SES: 2253; high SES: 1235). Survival following listing and transplantation was compared across strata. Risk-adjusted long-term mortality on the waitlist was higher among low SES patients (hazard 1.32, CI 1.07-1.63). The relationship between SES and outcomes varied by race. Early risk-adjusted post-transplant outcomes were worst among high SES patients (10.8% vs. low SES: 8.9%, p < 0.05). The incidence of non-compliance was higher among low SES patients (p < 0.0001). Long-term risk-adjusted patient survival was poorer among low (hazard 1.41, CI 1.10-1.80) and mid-SES (1.29, 1.04-1.59) groups. Low SES is associated with worse outcomes on both the waitlist and late following transplantation. Higher SES patients had more complex transplants with higher early mortality. Further research should be directed at identifying and addressing underlying causal factors for these disparities.

Original languageEnglish (US)
Pages (from-to)573-581
Number of pages9
JournalPediatric Transplantation
Volume17
Issue number6
DOIs
StatePublished - Sep 2013

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Keywords

  • children
  • heart transplant
  • social class

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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