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Socioeconomic Disparities Impact Heart Transplant Outcomes, Study Reveals
Recent research from UCLA indicates that heart transplant recipients living in economically disadvantaged neighborhoods face significantly higher risks of complications and mortality within five years post-surgery compared to those from more affluent areas. This disparity persists despite receiving care at leading high-volume hospitals.
These findings, set to be published on September 30 in the Journal of Heart and Lung Transplantation, highlight the critical role that socioeconomic factors play in health outcomes. Lead author Sara Sakowitz MS MPH, a medical student at UCLA’s David Geffen School of Medicine, pointed out that limited access to essential follow-up care may underlie these differences.
The study originally garnered attention at the 2024 Society of Thoracic Surgeons National Meeting, where it was awarded the J. Maxwell Chamberlain Memorial Paper for its significant contributions to the field of perioperative care.
Sakowitz emphasized, “Our research indicates that while patients may have access to advanced transplantation centers, this does not eliminate the ongoing disparities influenced by neighborhood socioeconomic factors. The issues arise from insufficient access to long-term care and access to critical immunosuppressive medications post-surgery.”
“This suggests that merely improving access to healthcare services isn’t enough to close the gap in post-transplant outcomes. We need to tackle the broader issues related to long-term care engagement that persist months and years after the transplant,” she added.
The researchers analyzed data from the Organ Procurement and Transplantation Network (OPTN) for adults undergoing heart transplants between January 2005 and December 2022, with outcomes tracked until June 2023. They utilized the Area Deprivation Index (ADI), which evaluates a combination of factors including economic status, hardship, inequality, and education levels to rate neighborhoods from 1 as the least deprived to 100 as the most deprived.
The primary outcomes measured included mortality at one, three, and five years after transplantation, alongside rates of organ failure during and after hospitalization.
Among the 38,000 heart transplant recipients analyzed, approximately 20% (7,600 individuals) resided in the most deprived areas. The findings revealed that these patients had a 14% higher risk of mortality at three years, and a 13% greater chance of dying by the five-year mark. They also faced a 14% elevated risk of organ failure at three years and a 13% higher risk at five years.
Even patients from deprived neighborhoods treated at high-quality institutions had a 10% increased likelihood of dying within three and five years compared to their peers from less disadvantaged areas, suggesting that higher quality care does not necessarily equate to improved outcomes for these patients.
The study identified that patients from economically disadvantaged communities often had higher incidences of diabetes, greater body mass indices, and more prevalent coronary disease compared to those from wealthier regions. Nevertheless, even after adjustments for factors such as race, insurance status, and pre-existing health conditions, the disparities remained evident.
“This indicates that socioeconomic disadvantage at the community level functions as a deep-rooted structural factor influencing post-transplant health outcomes,” the researchers stated.
Limitations of the study noted include the potential inadequacy of data granularity from OPTN, the absence of detailed information regarding the surgeons’ experience, and concerns that ADI measurements may not fully encapsulate patients’ socioeconomic statuses due to their calculation methods, which suggests that further research is necessary.
The research team is currently investigating various factors that might explain these disparities, including access to and adherence to post-transplant medications, as well as the effects of the surrounding residential environment on health outcomes.
Sakowitz commented, “Our objective is to thoroughly understand the intricate and varied relationships between social determinants and cardiac health outcomes. This understanding will aid in formulating targeted interventions that address these problems on both local and national levels. Tackling the systemic roots of disparities in transplantation necessitates deconstructing these large-scale challenges into manageable areas where meaningful improvements can occur.”
The study was conducted at UCLA’s Cardiovascular Outcomes Research Laboratories (CORELAB) within the Department of Surgery under the leadership of Dr. Peyman Benharash, who serves as the senior author of the report. Additional contributors include Dr. Syed Shahyan Bakhtiyar, Dr. Saad Mallick, Amulya Vadlakonda, Dr. Nikhil Chervu, and Dr. Richard Shemin, all affiliated with UCLA. Bakhtiyar is also associated with the University of Colorado.
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