People from socioeconomically distressed communities who underwent heart transplantation between 2004 and 2018 faced a 10% greater relative risk of experiencing graft failure and dying within five years compared to people from non-distressed communities, according to a study by UCLA researchers.
In addition, following implementation of the 2018 UNOS Heart Allocation policy, transplant recipients between 2018 and 2022 faced an approximately 20% increase in relative risk of dying or experiencing graft failure within three years compared with the pre-policy period. This is despite the fact that the proportion of distressed patients remained the same over both eras.
The researchers relied on 2004-2022 data from the Organ Procurement and Transplantation Network (OPTN) to ascertain the number of adult heart transplant patients, and the Distressed Communities Index (DCI), which uses neighborhood factors such as unemployment, poverty level, median income and housing vacancies to measure community socioeconomic inequity. Of 36,777 heart transplant patients, 7,450 were from distressed communities.
Structural community distress is linked with inferior survival following heart transplantation, with the disparity gap in outcomes widening since the 2018 Policy Change. Novel structural and systemic interventions addressing social determinants of health are needed to improve follow-up care and outcomes for vulnerable populations. Further, the DCI should be integrated into risk-stratification models to prevent risk-averse transplantation strategies that would disproportionately affect under-served patients. Given compounding ramifications from the COVID-19 pandemic, particularly on already vulnerable populations, the field of heart transplantation must directly confront expanding inequity in outcomes.
