Transplantation, Waitlist Status, and County Indices of Economic Health in West Virginia.

Abstract

Kidney transplantation is the optimal treatment for patients with end stage kidney disease. Given lower rates of kidney transplant in West Virginia (WV), we searched for potential predictors, focusing on indices of economic health. Data on initiation of kidney replacement therapy, being waitlisted for and receiving a kidney transplant between 1965 and 2020 were collected from United States Renal Data System (USRDS). Data on county poverty rate (PR) and economic distress were collected from the Appalachian Regional Commission. Of the 23,055 WV patients identified, 2,999 (13%) were transplanted compared to 514,050 (15.3%) for the rest of the US (p< 0.001). Patients who never received a kidney transplant were from counties with higher PRs (17.95%) compared to transplanted patients (17.44%); p<0.001. Waitlisted patients (2,375) came from counties with lower PRs than those who were never waitlisted (17.48 vs 17.94%; p<0.001). Waitlisted patients were less likely to be from distressed or at-risk counties (32 vs 34.3%; p=0.05) than patients who were never waitlisted. In multivariable logistic regression, county PR remained an independent predictor of being transplanted (OR 0.91, 95% CI: 0.85-0.97; p=0.008) or waitlisted (OR 0.9, 95% CI: 0.84-0.96; p=0.001) per 5% increase in poverty rate after adjusting for age, sex, BMI, alcohol use, functional status and comorbid medical conditions. Group/employer health insurance appeared to modify the relationship between PR and waitlist, where PR remained an independent predictor of waitlisting among patients with insurance. Waitlisted patients and transplant recipients from WV were more likely to hail from counties with lower PRs and those in better economic health.