Development and Validation of a Socioeconomic Kidney Transplant Derailers Index.
Development and Validation of a Socioeconomic Kidney Transplant Derailers Index.
复制标题
社会经济肾移植脱轨指数的开发和验证。
DOI：
10.1097/txd.0000000000000927
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发表时间：
2019
影响因子：
2.3
通讯作者：
Waterman,AmyD
中科院分区：
文献类型：
--
作者：
Peipert,JohnD;Beaumont,JenniferL;Robbins,MarkL;Paiva,AndreaL;Anderson,Crystal;Cui,Yujie;Waterman,AmyD
背景：社会经济障碍可以阻止成功的肾移植（KT），但在临床环境中很难有效衡量。我们创建并验证了个人水平的单分肾移植脱轨指数 (KTDI)，并评估了其与候补名单和活体捐献者 KT (LDKT) 率的关联。方法。数据集包括在加利福尼亚州移植中心进行 KT 评估的 733 名患者。探索性因素分析用于确定 KT 的社会经济障碍（脱轨因素）以纳入该指数。潜在的 KT 脱轨因素包括健康保险、就业、财务不安全、教育程度、邻里安全感、车辆使用权、洗衣机/烘干机以及社会支持质量。通过 KTDI 分数与以下各项之间的关联来测试有效性：(1) 区域剥夺指数 (ADI) 和 (2) KT 候补名单和 LDKT 的时间。结果。保留了 9 个脱轨因素，仅省略了原始集合中的社会支持水平。 KTDI 通过对认可的脱轨者数量进行求和来评分（平均值：3.0；范围：0-9）。黑人患者的 KTDI 估计评分高于其他患者组（与白人患者相比，分别为 3.8 与 2.1；P<0.001，效应大小 = 0.81）。此外，KTDI 与 ADI 相关（γ= 0.70，SE= 0.07；P < 0.001）。最后，与下三分位数相比，上三分位数和中三分位数的患者等待名单的风险较低（上三分位数风险比 [HR]：0.34，95% 置信区间 [CI]：0.25-0.45；中三分位数 HR：0.54，95% CI：0.40-0.72）和接受 LDKT（上三分位数 HR： 0.15，95% CI：0.08-0.30；中间三分位数 HR：0.35，95% CI：0.20-0.62）。在调整 ADI 和其他患者特征后，这些关联仍然显着。结论。KTDI 是个体患者接受 KT 的社会经济障碍的有效指标，可用于识别存在不接受 KT 风险的患者。
Background.Socioeconomic barriers can prevent successful kidney transplant (KT) but are difficult to measure efficiently in clinical settings. We created and validated an individual-level, single score Kidney Transplant Derailers Index (KTDI) and assessed its association with waitlisting and living donor KT (LDKT) rates.Methods.The dataset included 733 patients presenting for KT evaluation in a transplant center in California. Exploratory factor analysis was used to identify socioeconomic barriers to KT (derailers) to include in the index. Potential KT derailers included health insurance, employment, financial insecurity, educational attainment, perception of neighborhood safety, access to a vehicle, having a washer/dryer, and quality of social support. Validity was tested with associations between KTDI scores and the following:(1) the Area Deprivation Index (ADI) and (2) time to KT waitlisting and LDKT.Results.Nine derailers were retained, omitting only social support level from the original set. The KTDI was scored by summing the number of derailers endorsed (mean: 3.0; range: 0–9). Black patients had higher estimated KTDI scores than other patient groups (versus White patients, 3.8 versus 2.1; P< 0.001, effect size= 0.81). In addition, the KTDI was associated with the ADI (γ= 0.70, SE= 0.07; P< 0.001). Finally, in comparison to the lower tertile, patients in the upper and middle KTDI tertiles had lower hazard of waitlisting (upper tertile hazard ratio [HR]: 0.34, 95% confidence interval [CI]: 0.25-0.45; middle tertile HR: 0.54, 95% CI: 0.40-0.72) and receiving an LDKT (upper tertile HR: 0.15, 95% CI: 0.08-0.30; middle tertile HR: 0.35, 95% CI: 0.20-0.62). These associations remained significant when adjusting for the ADI and other patient characteristics.Conclusions.The KTDI is a valid indicator of socioeconomic barriers to KT for individual patients that can be used to identify patients at risk for not receiving a KT.