Jesse D. Schold|Emily Heaphy|Laura D. Buccini|Emilio D. Poggio|Titte R. Srinivas|David A. Goldfarb|Stuart M. Flechner|James R. Rodrigue|J. Daryl Thornton|Ashwini R. Sehgal
Prominent Impact of Community Risk Factors on Kidney Transplant Candidate Processes and Outcomes
Cleveland Clinic Lerner College of Medicine|Cleveland Clinic|MetroHealth Medical Center|Case Western Reserve University|Cleveland Clinic|Cleveland Clinic|Cleveland Clinic Lerner College of Medicine|Case Western Reserve University|Medical University of South Carolina|Cleveland Clinic Lerner College of Medicine|Case Western Reserve University|Cleveland Clinic Lerner College of Medicine|Case Western Reserve University|Beth Israel Deaconess Medical Center|MetroHealth Medical Center|Case Western Reserve University|MetroHealth Medical Center|Case Western Reserve University
numerous factors impact patients health beyond traditional clinical characteristics evaluated association risk factors kidney transplant patients communities outcomes prior transplantation primary exposure variable community risk score range 040 derived multiple databases defined factors including prevalence comorbidities access quality healthcare selfreported physical mental health socioeconomic status us county merged data scientific registry transplant recipients srtr utilized riskadjusted models evaluate effects community risk adult candidates listed 20042010 n 209 198 patients highest risk communities associated increased mortality adjusted hazard ratio ahr 122 116128 decreased likelihood living donor transplantation adjusted odds ratio aor 090 085094 increased waitlist removal health deterioration ahr 136 122151 decreased likelihood preemptive listing aor 085 081088 increased likelihood inactive listing aor 149 143155 increased likelihood listing expanded criteria donor kidneys ahr 119 115124 associations persisted adjustment ruralurban location furthermore independent effects ruralurban location largely eliminated adjustment community risk average community risk varied widely region transplant center median 21 range 537 community risks powerful factors associated processes care outcomes transplant candidates may important considerations developing effective interventions measuring quality care transplant centers