title: Kidney transplantation and the intensity of poverty in the contiguous United States.
abstract: BACKGROUND
  Geographic variation in kidney transplantation rates in the United States has been described previously but remains unexplained by age, race, sex, or socioeconomic status differences. Geographic variations in the concentration of poverty appear to impact end-stage renal disease care and potentially access to transplantation.
  
  
  METHODS
  We studied the impact of how spatial topography of poverty across geographical regions in the contiguous United States is associated with kidney transplantation in the 48 contiguous U.S. states.
  
  
  RESULTS
  We found considerable geographic variation in transplantation rates across the country that persisted across quartiles of county-level median household income and percentage minority population. Higher transplant rates were seen with increasing median household income and decreasing minority populations but were not influenced by education level. Transplantation rates in counties with poverty rates above the national average had low transplant rates, but these rates were influenced by the poverty level in the surrounding counties. Similarly, wealthy counties had higher transplant rates but were lowered in counties of relative wealth that were surrounded by less wealthy counties.
  
  
  CONCLUSIONS
  Our results underline the geographical heterogeneity of kidney transplantation in the United States and identify regions of the country most likely to benefit from interventions that may reduce disparities in transplantation.
authors.affiliation: 1 Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY. 2 Apex Health Innovations, Simi Valley, CA. 3 Department of Surgery, Division of Transplantation, Rollins School of Public Health, Emory University, Atlanta, GA. 4 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. 5 Centers for Disease Control and Prevention, Atlanta, GA. 6 Renal Division, Emory University School of Medicine, Atlanta, GA. 7 Address correspondence to: Sumit Mohan, M.D., M.P.H., Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, 622 W 168th Street, PH4-124, New York, NY 10032.
authors.forename: Sumit
authors.initials: S
authors.lastname: Mohan
authors.forename: Richard
authors.initials: R
authors.lastname: Mutell
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.forename: James
authors.initials: J
authors.lastname: Holt
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: William
authors.initials: W
authors.lastname: McClellan
mesh_terms: D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D011203:Poverty; D012923:Social Class; D009927:Tissue and Organ Procurement; D014481:United States