title: Socioeconomic position and graft failure in pediatric heart transplant recipients.
abstract: BACKGROUND
  Socioeconomic (SE) position may affect availability of resources, health-related behavior, and outcomes. We assessed whether patient SE position, determined for the block group of patient residence (average population 1000, smallest census unit with SE data), is associated with graft failure in pediatric heart transplant recipients.
  
  
  RESULTS
  We used the US Census 2000 database to derive a composite SE score for the block group of residence for all patients who underwent their first heart transplant at Children's Hospital Boston between 1991 and 2005 (n=135). Cox proportional hazards models were used to determine the risk of graft failure (death or retransplant) in the lowest tertile SE group (low SE group) compared with the remaining 2 of 3 patients (controls). The 2 groups were similar with respect to age, gender, diagnosis, and year of transplant. White race was less frequent in low SE group (64% versus 90%, P=0.001). Graft failure occurred in 46 transplant recipients (40 deaths, 6 retransplant). Low SE group (hazard ratio 2.4, 95% CI 1.3 to 4.3) and nonwhite race (hazard ratio 2.7, 95% CI 1.4 to 5.2) were both associated with higher risk of graft failure. In a multivariable model controlling for diagnosis and pretransplant support, race, and low SE position (hazard ratio 2.0, 95% CI 1.0 to 3.7, P=0.04) remained associated with graft failure. Low SE position group had a higher incidence rate of graft rejection and was at a higher risk of late rejection.
  
  
  CONCLUSIONS
  Low SE position may be an independent risk factor for graft failure in pediatric heart transplant recipients.
authors.affiliation: Departments of Cardiology and Cardiovascular Surgery, Children's Hospital Boston, Harvard Medical School, and Harvard School of Public Health, Boston, Mass02115, USA. TP.Singh@cardio.chboston.org
authors.forename: Tajinder P
authors.initials: TP
authors.lastname: Singh
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Bastardi
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Blume
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
mesh_terms: D000293:Adolescent; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D019992:Databases as Topic; D005260:Female; D006084:Graft Rejection / Q000208:ethnology / Q000209:etiology* / Q000401:mortality; D006085:Graft Survival; D007722:Health Knowledge, Attitudes, Practice; D006295:Health Resources / Q000706:statistics & numerical data; D016027:Heart Transplantation / Q000009:adverse effects* / Q000208:ethnology / Q000401:mortality; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult