Prominent Impact of Community Risk Factors on Kidney Transplant Candidate Processes and Outcomes

摘要: Numerous factors impact patients' health beyond traditional clinical characteristics. We evaluated the association of risk in kidney transplant communities with outcomes prior to transplantation. The primary exposure variable was a community score (range 0–40) derived from multiple databases and defined by including prevalence comorbidities, access quality healthcare, self-reported physical mental socioeconomic status for each U.S. county. merged data Scientific Registry Transplant Recipients (SRTR) utilized risk-adjusted models evaluate effects adult candidates listed 2004–2010 (n = 209 198). Patients highest were associated increased mortality (adjusted hazard ratio [AHR] = 1.22, 1.16–1.28), decreased likelihood living donor transplantation odds [AOR] = 0.90, 0.85–0.94), waitlist removal deterioration (AHR = 1.36, 1.22–1.51), preemptive listing (AOR = 0.85, 0.81–0.88), inactive (AOR = 1.49, 1.43–1.55) expanded criteria kidneys (AHR = 1.19, 1.15–1.24). Associations persisted adjustment rural–urban location; furthermore independent location largely eliminated risk. Average varied widely region center (median = 21, range 5–37). Community risks are powerful processes care may be important considerations developing effective interventions measuring centers.