Heart transplant patients residing in economically disadvantaged neighborhoods are more prone to experiencing complications after surgery and have a higher likelihood of dying within five years compared to those from wealthier areas. This holds true even when surgeries are performed at reputed, high-volume hospitals, according to new research from UCLA.
Research from UCLA indicates that heart transplant patients from socioeconomically challenged areas face a greater risk of post-surgical complications and a higher chance of dying within five years, compared to their counterparts from more affluent regions, despite being treated at leading high-volume hospitals.
These results, set to be published on September 30 in the peer-reviewed Journal of Heart and Lung Transplantation, which is the official publication of the International Society for Heart and Lung Transplantation, suggest that inadequate access to follow-up care, likely linked to neighborhood poverty, may be a significant reason for these disparities, as stated by the lead author, Sara Sakowitz MS MPH, a medical student at the David Geffen School of Medicine at UCLA.
The study was first presented at the 2024 Society of Thoracic Surgeons National Meeting, where it was recognized as the J. Maxwell Chamberlain Memorial Paper, awarded for being the best in perioperative care.
“Our research highlights that even having access to high-quality heart transplant centers fails to lessen ongoing disparities in patient and graft survival associated with neighborhood poverty,” Sakowitz commented. “Instead, elements outside the immediate post-transplant timeline, including access to essential long-term care and immunosuppressive medications, seem to play a crucial role.”
“This suggests that simply improving access to care is not enough to resolve ongoing inequalities in post-transplant results. We need to direct our efforts towards addressing disparities in long-term care access and engagement following transplantation,” she added.
The study analyzed data from the Organ Procurement and Transplantation Network (OPTN) concerning adults who received heart transplants between January 2005 and December 2022, with follow-up data available until June 2023. Researchers utilized a tool called the Area Deprivation Index (ADI), which aggregates a neighborhood’s financial stability, economic challenges, inequality, and educational levels, ranking regions from 1 (highest socioeconomic status or “least deprived”) to 100 (lowest socioeconomic status or “most deprived”).
The main outcomes measured were death rates at one, three, and five years post-transplant, along with complications during transplant hospitalization and rates of organ failure at three and five years.
Out of nearly 38,000 heart transplant recipients analyzed, around 20% (7,600 patients) hailed from the most deprived areas.
The research revealed that individuals from the most deprived communities faced a 14% increased risk of death by three years and a 13% higher mortality risk by five years. Additionally, they encountered a 14% greater risk of organ failure at three years and a 13% higher risk at five years.
Even when treated at top-tier hospitals, heart transplant patients from poorer neighborhoods had a 10% higher probability of dying at both three and five years compared to those from more affluent areas, indicating that care at a superior hospital did not correlate with significantly better outcomes.
Researchers noted that patients from low-income areas were more likely to suffer from diabetes, had a higher body mass index, and were more often diagnosed with coronary disease compared to those from wealthier backgrounds. However, the disparity persisted even after accounting for race, insurance coverage, and other health conditions.
“Thus, community-level socioeconomic disadvantages seem to function as a broader structural factor that significantly influences post-transplant outcomes,” the researchers concluded.
However, the study has limitations, such as potentially insufficient detail in OPTN data, lack of information on surgeon experience, and the possibility that ADI scores may not accurately capture patients’ socioeconomic conditions due to their calculation methods, suggesting a need for further investigation.
Meanwhile, the researchers are continuing to explore the factors that might contribute to these disparities, such as access to and adherence to post-transplant medications, as well as how residential and environmental factors affect health.
“Our aim is to comprehensively understand the complex and multifaceted links between social determinants and cardiac care outcomes, allowing us to create targeted solutions on both local and national levels,” Sakowitz said. “In tackling the systemic root causes of disparities in transplantation, we must dissect these large-scale issues into manageable parts where we can effect meaningful change.”
The research was conducted at the Cardiovascular Outcomes Research Laboratories (CORELAB) within the Department of Surgery, overseen by Dr. Peyman Benharash, the senior author. The study also included contributions from co-authors Dr. Syed Shahyan Bakhtiyar, Dr. Saad Mallick, Amulya Vadlakonda, Dr. Nikhil Chervu, and Dr. Richard Shemin from UCLA, with Bakhtiyar also associated with the University of Colorado.
