Following a report on racial disparities in organ transplantation, researchers asked whether socioeconomics or geography affects disparity.
The figure above shows post-transplant recipient death rates by donor and recipient state of residence. Maps are presented by donor (A) and recipient (B) race and ethnicity. Deaths represented as rates per 100 person-years (PY). Data are suppressed for states with 10 or fewer donors (A) or recipients (B).
After a national report highlighted racial disparities in organ transplantation, Cleveland Clinic researchers asked whether socioeconomic position or where a person lives played a role in this disparity.
Recent findings published in JAMA Open Network, showed that the answer is much more complicated than a simple yes or no. Researchers did not find evidence that socioeconomic status or region explained the differences in donor and recipient survival rates between race and ethnic groups, using the Area Deprivation Index (ADI), a tool to measure socioeconomic status in a geographic area.
Likely, location and socioeconomic factors like education and income still play a role in the racial inequities in survival, but the study indicates that one doesn’t explain the other which may be due to the highly selected population who ultimately access transplant in this country, says Carli Lehr, MD, PhD, first author on the study.
These findings are a starting point for broader conversations on these disparities and personalizing care, she says. That could include reviewing what data is collected about organ donors and recipients or examining what types of immunosuppressant drugs are prescribed after transplant.
The study found that non-Hispanic Black recipients experience an 11% higher chance of post-transplant mortality than non-Hispanic white patients, mirroring inequities highlighted in the 2022 national report published by the American Academies of Science, Engineering and Medicine.
“What we wanted to do was to really tackle this important topic, but in an open way that encouraged further dialogue and deeper exploration,” Dr. Lehr says. “Addressing this complicated issue will require us to peel back layers of how these inequities came to be, and this is a start for determining where we should focus to improve outcomes for our patients.”
Dr. Lehr is a staff pulmonologist and physician-scientist whose research focuses on new ways to analyze organ transplantation outcomes. Maryam Valapour, MD, MPP, Director of Cleveland Clinic’s Lung Transplant Outcomes at the Respiratory Institute, and Jarrod Dalton, PhD, Director for the Center for Populations Health Research, are co-authors on the study.
The study found that ADI may not have a close association with racial inequities because the population that receives organs is pre-selected from a waiting list. Because of factors associated with ADI, like difficulty accessing healthcare or lack of social support, some patients who medically would benefit from a transplant do not make it to the waiting list, Dr. Lehr says.
The findings also show that measures currently used to assess socioeconomic position, like ADI, might not be enough to accurately reflect problems for individual patients.
The Organ Procurement and Transplantation Network, which manages the national organ transplant system, does not collect socioeconomic data. A recommendation in the American Academies of Science, Engineering and Medicine report was to update the data collected as part of the network.
“Many of the measures we have for socioeconomic position, are based on either zip code or county-level data which may not provide detailed enough resolution– for example there can be significant variation of income and neighborhoods within these geographic boundaries, for example,” Dr. Lehr says. “We need to also consider the data we are collecting when interpreting findings that inform these important conversations around understanding and eliminating racial disparities to transplant access.”
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