Association between Area Deprivation Index and Listing for Heart Transplantation at an Academic Medical Center

Abstract

<h3>Purpose</h3> Socioeconomic deprivation may impede referral for heart transplant (HT) evaluation and impart barriers to listing. The area deprivation index (ADI) incorporates Census-derived measures of neighborhood disadvantage that include education, employment, income, poverty, and housing characteristics. We examined the association of ADI with HT listing among patients evaluated at our institution. <h3>Methods</h3> All HT evaluations at our institution from 1/1/2017-12/31/19 were reviewed. Patient sex, age, race, ethnicity, BMI, and primary insurance payer were recorded. Block group-level ADI decile (1-10 with 10 being the most disadvantaged) was obtained at each patient's home address. <h3>Results</h3> Of 330 patients evaluated for HT, 262 were presented at our selection meeting. ADI was obtained for 259 patients and assigned by multiple imputation for three. Among them, 27% were women, 54% white, 22% Black, and 16% Latino. Median age was 59 years (IQR 48-55) and median ADI decile was 4 (2-7). Our institutional neighborhood ADI is 9. In total, 206 (79.5%) candidates were listed for HT. ADI decile did not associate significantly with odds of listing (OR 0.94 [95% CI 0.85-1.04],p=0.21). Compared to those with commercial insurance, patients with Medicare (OR 0.36 [0.16-0.79],p=0.01) and dual coverage (OR 0.17 [0.06-0.44],p<0.001) had lower listing odds; association of Medicaid support was not significant (OR 0.68 [0.28-1.69],p=0.39). Distributions of ADI deciles among presented and listed patients are shown in the <b>Figure.</b> Among the 68 patients with closed evaluations, the median ADI was 5. <h3>Conclusion</h3> Among candidates presented for HT evaluation at our center, ADI did not associate with likelihood of listing. Lower listing odds for patients supported with Medicare or dual coverage may reflect longstanding illness. Additional studies will determine associations of ADI and insurance with bridging strategy, waitlist and post-HT outcomes.