title: Neighborhood level effects of socioeconomic status on liver transplant selection and recipient survival.
abstract: OBJECTIVE
  Previous studies have reported that patients of higher socioeconomic status (SES) have increased access to liver transplantation and reduced waitlist mortality than patients of lower SES. However, little is known about the association between SES and outcomes after liver transplantation.
  
  
  METHODS
  By using a link between the University HealthSystem Consortium and the Scientific Registry of Transplant Recipients databases, we identified 12,445 patients who underwent liver transplantation from 2007 through 2011. We used a proportional hazards model to assess the effect of SES on patient survival, controlling for characteristics of recipients, donors, geography, and center.
  
  
  RESULTS
  Compared with liver recipients in the lowest SES quintile, those in the highest quintile were more likely to be male, Caucasian, have private insurance, and undergo transplantation when they had lower Model for End-Stage Liver Disease scores. In proportional hazards model analysis, liver recipients of the lowest SES were at an increased risk for death within a median of 2 years after transplantation (hazard ratio, 1.17; 95% confidence interval, 1.02-1.35).
  
  
  CONCLUSIONS
  Patients of lower SES appear to face barriers to liver transplantation, but perioperative outcomes (length of stay, in-hospital mortality, or 30-day readmission) do not differ significantly from those of patients of higher SES. However, fewer patients of low SES survive for 2 years after transplantation, independent of features of the recipient, donor, surgery center, or location.
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: R Cutler
authors.initials: RC
authors.lastname: Quillin
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: University Health Consortium and Department Health Systems Management, Rush University, Chicago, Illinois.
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Hohmann
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Shaw
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paquette
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio. Electronic address: shimul.shah@uc.edu.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012923:Social Class; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Disparities; Fixed Effects; Race; SRTR; UHC