Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live-Donor and Preemptive Kidney Transplantation.

ABSTRACT

INTRODUCTION: Adults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live-donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity. METHODS: We studied 403 937 adults (age ≥ 18) KT candidates (national transplant registry; 2006-2021). NDI and its 10 components were averaged at the ZIP-code level. Cause-specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components. RESULTS: Candidates residing in high-deprivation neighborhoods were more likely to be female (40.1% vs. 36.2%) and Black (41.9% vs. 17.7%), and were less likely to receive both LDKT (aHR = 0.66, 95% confidence interval [CI] 0.64-0.67) and preemptive KT (aHR = 0.60, 95% CI 0.59-0.62) than those in low-deprivation neighborhoods. These associations differedby race and ethnicity (Black aHRLDKT = 0.58, 95% CI 0.55-0.62; aHRpreemptive KT = 0.68, 95% CI 0.63-0.73; Pinteractions LDKT < 0.001; Preemptive KT = 0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value) for example, higher median household income (LDKT aHR = 1.08, 95% CI 1.07-1.09; Preemptive KT aHR = 1.10, 95% CI 1.08-1.11) and educational attainments (≥high school [LDKT aHR = 1.17, 95% CI 1.15-1.18; Preemptive KT aHR = 1.23, 95% CI 1.21-1.25]). CONCLUSION: Residence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood-level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.