Association of Socioeconomic Position With Racial and Ethnic Disparities in Survival After Lung Transplant.
Association of Socioeconomic Position With Racial and Ethnic Disparities in Survival After Lung Transplant.
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DOI：
10.1001/jamanetworkopen.2023.8306
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发表时间：
2023-04-03
影响因子：
13.8
通讯作者：
Dalton, Jarrod E.
中科院分区：
文献类型：
--
作者：
Lehr, Carli J.;Valapour, Maryam;Gunsalus, Paul R.;McKinney, Warren T.;Berg, Kristen A.;Rose, Johnie;Dalton, Jarrod E.
肺移植后的种族差异是由社会经济地位和地区介导的吗？在这项对19504例肺移植供体和受体的队列研究中，社会经济地位和地区并不能解释在不同种族和民族之间观察到的移植后结局的大部分差异。在这项研究中，尽管努力解释社会经济地位和地区的差异，但种族和民族的生存差异仍然存在，这一发现突出了复杂的社会现实的存在，需要继续研究以提高移植后结果的公平性。这项队列研究评估了供体和受体的社会经济地位和地区作为观察到的肺移植后生存的种族和民族差异的中介的作用。美国国家科学院、工程院和医学院最近的一项研究发现，移植结果因多种因素而存在很大差异，包括种族、民族和地理位置。他们提出了一些建议，包括研究改善器官分配公平性的机会。评估供体和受体的社会经济地位和地区作为移植后生存率观察到的种族和民族差异的中介的作用。这项队列研究纳入了肺移植供体和受体，并提供了2011年9月1日至2021年9月1日期间的种族和民族信息以及邮政编码列表区域定义的区域剥夺指数（ADI），其数据保存在美国移植登记处。数据分析时间为2022年6月至12月。种族，邻里劣势，以及捐赠者和接受者的区域。采用单变量和多变量考克斯比例风险回归分析供、受者种族与ADI对移植后生存率的关系。采用Kaplan-Meier法估计供、受者ADI。按种族拟合广义线性模型，并进行中介分析。贝叶斯条件自回归泊松率模型（1，州水平的空间随机效应; 2，模型1与人种和种族的固定效应，3;模型2不包括地区;和4：模型1与美国地区的固定效应）用于表征移植后死亡率的变化，并使用死亡率与全国平均水平的比值进行比较。总计19504例肺移植供体（中位数[IQR]年龄，33 [23-46]岁; 3117 [16.0%]西班牙裔个体，3667 [18.8%]非西班牙裔黑人个体，11935 [61.2%]非西班牙裔白色个体）和接受者（中位数[IQR]年龄，60 [51-66]岁; 1716 [8.8%]西班牙裔个体，1861 [9.5%]非西班牙裔黑人个体和15375 [78.8%]非西班牙裔白色个体）。ADI不介导非西班牙裔黑人和非西班牙裔白色受体之间移植后生存率的差异;它介导非西班牙裔黑人和西班牙裔受体之间生存率差异的4.1%。空间分析显示，非西班牙裔黑人受者移植后死亡的风险增加可能与居住地区有关。在这项肺移植供体和受体的队列研究中，社会经济地位和居住地区并不能解释种族和民族之间移植后结局的大部分差异，这可能是由于移植前人群的高度选择性。进一步的研究应该评估其他潜在的介导作用，有助于移植后生存的不公平。
Are racial disparities after lung transplant mediated by socioeconomic status and region? In this cohort study of 19 504 lung transplant donors and recipients, socioeconomic position and region did not explain most of the differences observed in posttransplant outcomes across race and ethnicity. In this study, differential survival by race and ethnicity existed despite efforts to account for variation by socioeconomic position and region, a finding that highlights the presence of a complex social reality that warrants continued study to improve equity in posttransplant outcomes. This cohort study evaluates the role of donor and recipient socioeconomic position and region as a mediator of observed racial and ethnic differences in post–lung transplant survival. A recent National Academies of Sciences, Engineering, and Medicine study found that transplant outcomes varied greatly based on multiple factors, including race, ethnicity, and geographic location. They proposed a number of recommendations including studying opportunities to improve equity in organ allocation. To evaluate the role of donor and recipient socioeconomic position and region as a mediator of observed racial and ethnic differences in posttransplant survival. This cohort study included lung transplant donors and recipients with race and ethnicity information and a zip code tabulation area–defined area deprivation index (ADI) from September 1, 2011, to September 1, 2021, whose data were in the US transplant registry. Data were analyzed from June to December 2022. Race, neighborhood disadvantage, and region of donors and recipients. Univariable and multivariable Cox proportional hazards regression were used to study the association of donor and recipient race with ADI on posttransplant survival. Kaplan-Meier method estimation was performed by donor and recipient ADI. Generalized linear models by race were fit, and mediation analysis was performed. Bayesian conditional autoregressive Poisson rate models (1, state-level spatial random effects; 2, model 1 with fixed effects for race and ethnicity, 3; model 2 excluding region; and 4: model 1 with fixed effects for US region) were used to characterize variation in posttransplant mortality and compared using ratios of mortality rates to the national average. Overall, 19 504 lung transplant donors (median [IQR] age, 33 [23-46] years; 3117 [16.0%] Hispanic individuals, 3667 [18.8%] non-Hispanic Black individuals, and 11 935 [61.2%] non-Hispanic White individuals) and recipients (median [IQR] age, 60 [51-66] years; 1716 [8.8%] Hispanic individuals, 1861 [9.5%] non-Hispanic Black individuals, and 15 375 [78.8%] non-Hispanic White individuals) were included. ADI did not mediate the difference in posttransplant survival between non-Hispanic Black and non-Hispanic White recipients; it mediated only 4.1% of the survival difference between non-Hispanic Black and Hispanic recipients. Spatial analysis revealed the increased risk of posttransplant death among non-Hispanic Black recipients may be associated with region of residence. In this cohort study of lung transplant donors and recipients, socioeconomic position and region of residence did not explain most of the difference in posttransplant outcomes among racial and ethnic groups, which may be due to the highly selected nature of the pretransplant population. Further research should evaluate other potentially mediating effects contributing to inequity in posttransplant survival.
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影响因子：
3.4
作者：
Chantarat, Tongtan;Van Riper, David C.;Hardeman, Rachel R.
通讯作者：
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影响因子：
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