title: Association of race and socioeconomic position with outcomes in pediatric heart transplant recipients.
abstract: We assessed the association of socioeconomic (SE) position with graft loss in a multicenter cohort of pediatric heart transplant (HT) recipients. We extracted six SE variables from the US Census 2000 database for the neighborhood of residence of 490 children who underwent their primary HT at participating transplant centers. A composite SE score was derived for each child and four groups (quartiles) compared for graft loss (death or retransplant). Graft loss occurred in 152 children (122 deaths, 30 retransplant). In adjusted analysis, graft loss during the first posttransplant year had a borderline association with the highest SE quartile (HR 1.94, p = 0.05) but not with race. Among 1-year survivors, both black race (HR 1.81, p = 0.02) and the lowest SE quartile (HR 1.77, p = 0.01) predicted subsequent graft loss in adjusted analysis. Among subgroups, the lowest SE quartile was associated with graft loss in white but not in black children. Thus, we found a complex relationship between SE position and graft loss in pediatric HT recipients. The finding of increased risk in the highest SE quartile children during the first year requires further confirmation. Black children and low SE position white children are at increased risk of graft loss after the first year.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, MA, USA. TP.Singh@cardio.chboston.org
authors.forename: T P
authors.initials: TP
authors.lastname: Singh
authors.forename: D C
authors.initials: DC
authors.lastname: Naftel
authors.forename: L
authors.initials: L
authors.lastname: Addonizio
authors.forename: W
authors.initials: W
authors.lastname: Mahle
authors.forename: M T
authors.initials: MT
authors.lastname: Foushee
authors.forename: S
authors.initials: S
authors.lastname: Zangwill
authors.forename: E D
authors.initials: ED
authors.lastname: Blume
authors.forename: J K
authors.initials: JK
authors.lastname: Kirklin
authors.forename: R
authors.initials: R
authors.lastname: Singh
authors.forename: J K
authors.initials: JK
authors.lastname: Johnston
authors.forename: R
authors.initials: R
authors.lastname: Chinnock
mesh_terms: D000293:Adolescent; D044383:Black People; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000208:ethnology* / Q000401:mortality; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D008297:Male; D011184:Postoperative Period; D012086:Reoperation; D012111:Residence Characteristics; D018570:Risk Assessment; D012923:Social Class; D013997:Time Factors; D017211:Treatment Failure; D044465:White People