Lung transplantation outcomes in patients from socioeconomically distressed communities

BACKGROUND: Previous studies have demonstrated racial and gender disparities in lung allocation, but contemporary data regarding socioeconomic disparities in post-transplant outcomes are lacking. We evaluated the impact of a composite socioeconomic disadvantage index on post-transplant outcomes.METHODS: The Scientific Registry of Transplant Recipients identified 27,763 adult patients undergoing isolated primary lung transplantation between 2005 and 2020. Zip code-level socioeconomic distress was characterized using the Distressed Communities Index (DCI: 0-no distress, 100-severe distress) based on education level, poverty, unemployment, housing vacancies, median income, and business growth, and patients were stratified into high (DCI >= 60) or low (DCI < 60) distressed groups.RESULTS: Recipients from high-distress communities (n = 8006, 28.8%) were younger (59 years [interquartile range {IQR} 50-64] vs 61 years [IQR 52-66]), less often white (73 vs 85%), less likely to have a college degree (45 vs 59%), and more likely to have public insurance (57 vs 49%, all p < 0.001) compared to those from low-distress communities. Additionally, high-distress recipients were more likely to have group A diagnoses (32 vs 27%) and undergo bilateral lung transplants (72.4 vs 69.3%, all p < 0.001). Post-transplant survival at 5 years was 55.7% (95% confidence interval [CI]: 54.4-56.9) in high-distress recipients and 58.2% (95% CI: 57.4-58.9) in low-distress recipients (p = 0.003). After adjustment, high distress level was independently associated with an increased risk of 5-year mortality (hazard ratio:1.09, 95% CI:1.04-1.15). CONCLUSIONS: Recipients from distressed communities are at increased mortality risk following lung transplantation. Efforts should be focused on increased resource allocation and further study to better understand factors which may mitigate this disparity. (c) 2023 International Society for Heart and Lung Transplantation. All rights reserved.

Automated summary

The study found that lung transplant recipients from economically distressed communities have lower post-transplant survival rates, which may be related to younger recipient age, different racial composition, lower education levels, and insurance situations. Therefore, efforts should be made to increase resource allocation and further research to understand factors that mitigate this inequality.