Jesse D. Schold|Laura D. Buccini|Michael W. Kattan|David A. Goldfarb|Stuart M. Flechner|Titte R. Srinivas|Emilio D. Poggio|Richard Fatica|Liise K. Kayler|Ashwini R. Sehgal
The Association of Community Health Indicators With Outcomes for Kidney Transplant Recipients in the United States
Western University of Health Sciences|Case Western Reserve University|Case Western Reserve University|Case Western Reserve University|Case Western Reserve University|Case Western Reserve University|Yeshiva University
evaluate association community health indicators outcomes kidney transplant recipientsretrospective observational cohort study using multivariable cox proportional hazards modelstransplant recipients united states scientific registry transplant recipients merged health indicators compiled several national databases centers disease control prevention including national center health statistics behavioral risk factor surveillance system national center chronic disease prevention health promotiona total 100 164 living deceased donor adult aged 18 years kidney transplant recipients underwent transplant january 1 2004 december 31 2010riskadjusted time posttransplant mortality graft lossmultiple health indicators recipients residence independently associated outcomes including low birth weight preventable hospitalizations inactivity rate smoking obesity prevalence recipients highestrisk counties likely african american adjusted odds ratio 159 95 ci 151168 younger aged 1839 years 146 132160 lower educational attainment high school 184 162208 public insurance 146 138154 proportions recipients higherrisk counties varied dramatically center region independent graded effect health indicators posttransplant mortality including notable hazard associated highestrisk counties adjusted hazard ratio 126 95 ci 113140in national cohort patients undergoing complex medical procedures health indicators patients communities strong independent predictors allcause mortality findings highlight importance community conditions risk stratification patients development individualized treatment protocols findings also demonstrate standard risk adjustment capture important factors may affect unbiased performance evaluations transplant centers