61 The Association between Poor Socioeconomic Status and Poor Long-Term Outcomes Following Heart Transplantation

Abstract

Purpose: While race is a risk factor for poor long-term outcomes after heart transplantation, little data exists examining the impact of socioeconomic status. Methods and Materials: We linked data from the UNOS/SRTR 19952009 with 2000 US Census data. A previously validated measure of socioeconomic status (SES) was calculated using 8 census variables for each patient based on zip code and race. Patients were stratified into three groups: low SES (score -30 to -2.1, n 10,441), medium SES (score -2.14 to 5.5, n 20,874), and high SES (score 5.5 to 23.4, n 10,438). Outcomes were compared between groups. Results: Lower SES patients had poorer long-term survival on the waitlist (p 0.0014) and were less likely to receive a transplant (p 0.0001). Following transplantation, 30-day mortality was unaffected by SES, but 1-year mortality was higher in the lowSES group (odds ratio 1.14, 95%CI 1.05-1.24). Long-term survival was significantly decreased by lower SES (Figure, p 0.0001). Patients in the low SES had a higher incidence of rejection (hazard ratio 1.1, 95%CI 1.0-1.2) and were more likely to be poorly compliant with medications (1.6, 1.3-1.9). In a Cox proportional hazard model, both low SES (hazard ratio 1.4, 95%CI 1.3-1.5) and mid SES (1.1, 1.0-1.2) were associated with decreased long-term survival after transplantation. Cause of graft failure did not differ significantly.