Neighborhood Socioeconomic Deprivation is Associated with Worse Outcomes in Pediatric Kidney Transplant Recipients

Key Points This is the largest US cohort study investigating neighborhood socioeconomic deprivation and outcomes among pediatric kidney transplant recipients. High neighborhood deprivation was associated with worse graft survival and lower access to preemptive and living donor transplantation. Findings demonstrate inequities in pediatric kidney transplantation associated with neighborhood-level factors that warrant intervention. Background Social determinants of health shape a child's transplant course. We describe the association between neighborhood socioeconomic deprivation, transplant characteristics, and graft survival in US pediatric kidney transplant recipients. Methods US recipients younger than 18 years at the time of listing transplanted between January 1, 2010, and May 31, 2022 ( N =9178) were included from the Scientific Registry of Transplant Recipients. Recipients were stratified into three groups according to Material Community Deprivation Index score, with greater score representing higher neighborhood socioeconomic deprivation. Outcomes were modeled using multivariable logistic regression and Cox proportional hazards models. Results Twenty-four percent ( n =110) of recipients from neighborhoods of high socioeconomic deprivation identified as being of Black race, versus 12% ( n =383) of recipients from neighborhoods of low socioeconomic deprivation. Neighborhoods of high socioeconomic deprivation had a much greater proportion of recipients identifying as being of Hispanic ethnicity (67%, n =311), versus neighborhoods of low socioeconomic deprivation (17%, n =562). The hazard of graft loss was 55% higher (adjusted hazards ratio [aHR], 1.55; 95% confidence interval [CI], 1.24 to 1.94) for recipients from neighborhoods of high versus low socioeconomic deprivation when adjusted for base covariates, race and ethnicity, and insurance status, with 59% lower odds (adjusted odds ratio [aOR], 0.41; 95% CI, 0.30 to 0.56) of living donor transplantation and, although not statistically significant, 8% lower odds (aOR, 0.92; 95% CI, 0.72 to 1.19) of preemptive transplantation. The hazard of graft loss was 41% higher (aHR, 1.41; 95% CI, 1.25 to 1.60) for recipients from neighborhoods of intermediate versus low socioeconomic deprivation when adjusted for base covariates, race and ethnicity, and insurance status, with 27% lower odds (aOR, 0.73; 95% CI, 0.66 to 0.81) of living donor transplantation and 11% lower odds (aOR, 0.89; 95% CI, 0.80 to 0.99) of preemptive transplantation. Conclusions Children from neighborhoods of high socioeconomic deprivation have worse graft survival and lower utilization of preemptive and living donor transplantation. These findings demonstrate inequities in pediatric kidney transplantation that warrant further intervention.