Marked variation in disease acuity and outcomes on the liver transplant waiting list by sociodemographic characteristics.

Abstract

Understanding the association of social determinants of health (SDOH) with liver transplant listing and wait list outcomes can inform healthcare policy and interventions aimed at improving access to care. We analyzed the Scientific Registry of Transplant Recipients database merged with the Social Deprivation Index (SDI) to evaluate if area of residence is associated with Model for End-Stage Liver Disease incorporating sodium (MELD-NA) at time of wait list placement and outcomes following wait listing, and if this varied based on sociodemographic variables. Compared to candidates residing in areas of low SDI), those residing in areas of high SDI (most socioeconomic disadvantage) had 11% higher adjusted likelihood [aOR (95% CI)=1.11(CI 1.05,1.17)] of being listed for transplant with a MELD-NA score ≥30; this was not statistically significant when also adjusted for race/ethnicity [aOR=1.02(0.97,1.08)]. When stratified by race/ethnicity, residing in an area of high SDI was associated with a MELD-NA score ≥30 at time of wait listing among Hispanic White candidates (aOR=1.24, 95% CI: 1.04, 1.49). Candidates residing in areas of high SDI had 8% lower chance [aHR=0.92 (0.88,0.96)] of undergoing a liver transplant, 6% higher risk of death [aHR=1.06(1.002,1.13)], and 20% higher risk [aHR=1.20(1.13,1.28)] of removal on the wait list independent of race, ethnicity, insurance status, or sex. In the US, residence in areas of high socioeconomic disadvantage is significantly associated with higher MELD-NA at the time of wait listing among Hispanic White candidates. In addition, residence in areas of high socioeconomic disadvantage was associated with a higher risk of death or removal from the wait list and lower chances of receiving a liver transplant after wait list placement, particularly among Non-Hispanic White candidates and older candidates.