title: Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients.
abstract: Socioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation. The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of studies analyzing this measure longitudinally or between races.
  
  
  
  Longitudinal cohort study in adult kidney transplantation transplanted at a single-center between 2005 and 2012. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a minimum of 0 and maximum of 3 for an aggregate of 0 to 15 (higher score → better SES).
  
  
  
  One thousand one hundred seventy-one patients were included; 624 (53%) were African American (AA) and 547 were non-AA. African Americans had significantly lower mean baseline SAI scores (AAs 6.5 vs non-AAs 7.8; P < 0.001). Cox regression analysis demonstrated that there was no association between baseline SAI and acute rejection in non-AAs (hazard ratio [HR], 0.92; 95% confidence interval [95% CI], 0.81-1.05), whereas it was a significant predictor of acute rejection in AAs (HR, 0.89; 95% CI, 0.80-0.99). Similarly, a 2-stage approach to joint modelling of time to graft loss and longitudinal SAI did not predict graft loss in non-AAs (HR, 1.01; 95% CI, 0.28-3.62), whereas it was a significant predictor of graft loss in AAs (HR, 0.23; 95% CI, 0.06-0.93).
  
  
  
  After controlling for confounders, SAI scores were associated with a lower risk of acute rejection and graft loss in AA kidney transplant recipients, whereas neither baseline nor follow-up SAI predicted outcomes in non-AA kidney transplant recipients.
authors.affiliation: 1 Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC. 2 Department of Pharmacy, Ralph H Johnson VAMC, Charleston, SC. 3 College of Medicine, Medical University of South Carolina, Charleston, SC. 4 Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 5 Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC. 6 Division of Transplant Nephrology, College of Medicine, Medical University of South Carolina, Charleston, SC. 7 Veterans Affairs HSR&D Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H Johnson VAMC, Charleston, SC.
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
authors.forename: Mahsa
authors.initials: M
authors.lastname: Hamedi
authors.forename: James R
authors.initials: JR
authors.lastname: Rodrigue
authors.forename: Mulugeta G
authors.initials: MG
authors.lastname: Gebregziabher
authors.forename: Titte R
authors.initials: TR
authors.lastname: Srinivas
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D051437:Renal Insufficiency / Q000191:economics* / Q000208:ethnology / Q000601:surgery; D012189:Retrospective Studies; D012923:Social Class; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents