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Social determinants of health among transplant patients data report now available

Published on: Friday, October 18, 2024

The Organ Procurement and Transplantation Network (OPTN) has produced a data report on social determinants of health (SDOH) among adult solid organ transplant candidates, recipients, and living donors in 2022.  SDOH are the conditions in the environments where people are born, live, learn, work, and age. These conditions may affect a wide range of quality-of-life and health outcomes. SDOH are not related to an individual’s biology or genetic makeup; instead, they are factors of one’s own culture, living environment, and community. Understanding the relationship between SDOH and waiting list outcomes is an important part of creating more equitable allocation systems.

Measures of SDOH used in this report include:

  • Estimated individual annual income
  • Neighborhood median household income
  • Education
  • Health insurance type
  • Area Deprivation index (ADI)
    • The Area Deprivation Index (ADI) is based on a measure created by the Health Resources & Services Administration (HRSA) that ranks neighborhoods by level of socioeconomic disadvantage on a scale of 1-100. Higher ADI values indicate higher levels of socioeconomic disadvantage.

Key results and findings

This report examines SDOH for adult candidates waiting for an organ and adult transplant recipients in 2022 by organ type (kidney, kidney-pancreas, pancreas, liver, heart, and lung).

  • Median estimated individual annual income was $66,000 for candidates and $68,000 for recipients. In general, estimated individual income was lower among non-Hispanic Black, Hispanic/Latino, and younger candidates.
  • For kidney, kidney-pancreas, and lung, greater proportions of recipients were insured by Medicare relative to candidates.
  • Waiting list mortality rates for kidney, liver, and heart candidates were significantly higher for candidates insured by Medicare relative to candidates with private insurance or Medicaid.
  • Lower estimated individual annual income and lower neighborhood median household income were associated with higher waiting list mortality rates for liver candidates.
  • Increasing estimated individual annual income, neighborhood median household income, and education were associated with decreasing deceased donor kidney transplant rates.
  • Increasing neighborhood disadvantage as measured by the ADI was associated with decreasing deceased donor transplant rates for heart but increasing deceased donor transplant rates for kidney and liver.

Data sources

This report linked OPTN data with data obtained from LexisNexis, a commercial data source that uses a proprietary algorithm to combine data from multiple sources, including credit checks, and government records, and the area deprivation index.

What’s next?

Data and analysis from this report will be presented to several OPTN committees in the coming months. Results from this project will inform future studies that examine relationships between SDOH, waiting list outcomes, and post-transplant outcomes.