Social Adaptability Index predicts access to kidney transplantation.
Identifying the group of subjects prone to disparities in access to kidney transplantation is important for developing potential interventions. Data from the United States Renal Data System (January 1, 1990-September 1, 2007; n = 3407) were used to study association between the Social Adaptability Index (SAI; based upon employment, marital status, education, income, and substance abuse) and outcomes (time to being placed on the waiting list and time to being transplanted once listed). Patients were 56.9 ± 16.1 yr old, 54.2% men, 64.2% white, and 50.4% had diabetes. SAI was higher in whites (7.4 ± 2.4) than African Americans (6.5 ± 2.6) [ANOVA, p < 0.001] and greater in men (7.4 ± 2.4) than in women (6.7 ± 2.5) [T-test, p < 0.001]. In multivariate model, greater SAI (range 0-12) was associated with increased likelihood of being placed on the waiting list (hazard ratio [HR] 1.19 [95% CI 1.15-1.23] per each point of increase in SAI, p < 0.001) and greater likelihood of receiving a transplant once listed (HR of 1.06 [95% CI 1.03-1.09] per point of increase in SAI, p < 0.001). Similar trends were observed in most of the subgroups (based upon race, sex, diabetic status, age, comorbidities, and donor type). SAI is associated with access to renal transplantation in patients with end-stage renal disease; it may be used to indentify individuals at risk of healthcare disparities.
Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. agoldfar@bidmc.harvard.edu
Alexander S
AS
Goldfarb-Rumyantzev
Gurprataap S
GS
Sandhu
Bradley C
BC
Baird
Muhammad
M
Khattak
Anna
A
Barenbaum
Douglas W
DW
Hanto
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D016030:Kidney Transplantation / Q000401:mortality* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D044469:Racial Groups; D012917:Social Adjustment; D015996:Survival Rate; D014850:Waiting Lists; D055815:Young Adult