Socioeconomic Deprivation and Survival After Heart Transplantation in England: An Analysis of the United Kingdom Transplant Registry.
Socioeconomic deprivation (SED) is associated with shorter survival across a range of cardiovascular and noncardiovascular diseases. The association of SED with survival after heart transplantation in England, where there is universal healthcare provision, is unknown.



Long-term follow-up data were obtained for all patients in England who underwent heart transplantation between 1995 and 2014. We used the United Kingdom Index of Multiple Deprivation (UK IMD), a neighborhood level measure of SED, to estimate the relative degree of deprivation for each recipient. Cox proportional hazard models were used to examine the association between SED and overall survival and conditional survival (dependant on survival at 1 year after transplantation) during follow-up. Models were stratified by transplant center and adjusted for donor and recipient age and sex, ethnicity, serum creatinine, diabetes mellitus, and heart failure cause. A total of 2384 patients underwent heart transplantation. There were 1101 deaths during 17 040 patient-year follow-up. Median overall survival was 12.6 years, and conditional survival was 15.6 years. Comparing the most deprived with the least deprived quintile, adjusted hazard ratios for all-cause mortality were 1.27 (1.04-1.55;P=0.021) and 1.59 (1.22-2.09;P=0.001) in the overall and conditional models, respectively. Median overall survival and conditional survival were 3.4 years shorter in the most deprived quintile than in the least deprived.



Higher SED is associated with shorter survival in heart transplant recipients in England and should be considered when comparing outcomes between centers. Future research should seek to identify modifiable mediators of this association.
From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.). jonathanevans3@nhs.net.
Jonathan D W
JD
Evans
From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.).
Stephen
S
Kaptoge
From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.).
Rishi
R
Caleyachetty
From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.).
Emanuele
E
Di Angelantonio
From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.).
Clive
C
Lewis
From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.).
K Jayan
KJ
Parameshwar
From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.).
Stephen J
SJ
Pettit
D000328:Adult; D000367:Age Factors; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics*; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
England; heart failure; heart transplantation; proportional hazards models