Associations between social determinants of health and abdominal solid organ transplant wait-lists in the United States.

Abstract

Societal factors that influence wait-listing for transplantation are complex and poorly understood. Social determinants of health (SDOH) affect rates of and outcomes after transplantation. This cross-sectional study investigated the impact of SDOH on additions to state-level, 2017-2018 kidney and liver wait-lists. Principal components analysis, starting with 127 variables among 3142 counties, was used to derive novel, comprehensive state-level composites, designated (1) health/economics and (2) community capital/urbanicity. Stepwise multivariate linear regression with backwards elimination (n=51; 50 states and DC) tested the effects of these composites, Medicaid expansion, and center density on adult disease burden-adjusted wait-list additions. SDOH related to increased community capital/urbanicity were independently associated with wait-listing (starting models: B=.40, P =.010 Kidney; B =.36, P =.038 Liver) (final models: B =.31, P =.027 Kidney, B =.34, P =.015 Liver). In contrast and surprisingly, no other covariates were associated with wait-listing (P≥.122). These results suggest that deficits in community resources are important contributors to disparities in wait-list access. Our composite SDOH metrics may help identify at-risk communities, which can be the focus of local and national policy initiatives to improve access to organ transplantation.