Work

Association between Area Deprivation Index, Kidney Transplant Waitlisting, and Reasons for Denial

Year: 2025

Type: article

Abstract: KEY POINTS: Patients from highly disadvantaged neighborhoods waited longer and were less likely to be placed on the kidney transplant waitlist. These patients faced higher odds of denial for medical, psychosocial, and body mass index-related reasons during evaluation. Findings point to the need for tailored interventions to address multifaceted barriers to transplant access for this population. BACKGROUND: Neighborhood socioeconomic disadvantage may affect kidney transplant (KT) access and reasons for waitlist denial. We assessed ( 1 ) the association between area deprivation index (ADI) and time-to-KT waitlisting and ( 2 ) whether evaluation outcomes differ by ADI quartile. METHODS: We conducted a retrospective cohort study of 4896 adults who were referred for KT evaluation from January 2015 to December 2021 at the University of Washington, using data collected from the electronic medical record. We used Cox proportional hazards models to evaluate the association of ADI quartile and time to KT waitlisting, adjusting for individual medical and social variables. Multinomial logistic regression was used to assess if KT evaluation outcomes (including waitlist denial reason) differed across ADI quartiles. RESULTS: Among the 3638 patients who initiated evaluation, 1381 (38%) were waitlisted. Residents in ADI quartile 4 (most disadvantaged) required longer time and were 27% less likely to be waitlisted than residents in Q1 (least disadvantaged) in the adjusted analysis (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.62 to 0.87). Residents in quartile 4 were more likely to be denied for medical reasons (aOR, 2.83; 95% CI, 2.03 to 3.95), nonmedical reasons (aOR, 2.56; 95% CI, 1.80 to 3.64), or for higher body mass index (aOR, 2.47; 95% CI, 1.40 to 4.36) than residents in Q1. CONCLUSIONS: Residents in disadvantaged neighborhood required longer time and had lower likelihood of KT waitlisting, with variable reasons for denial (medical, psychosocial, and body mass index), suggesting a need for individualized interventions to improve KT access. Further work, including qualitative methods, may better specify barriers and inform future interventions to address this disparity.

Source: Clinical Journal of the American Society of Nephrology

DOI: 10.2215/cjn.0000000939