The Impact of Social Determinants of Health and Race Disparities in Heart Transplant Long-Term Survival

Introduction: : Patients of color have a higher early mortality risk after heart transplantation than White recipients, even after taking differences in comorbidities into account. We aimed to assess long-term heart transplantation success based on patient's social determinants of health. Hypothesis: Socio-demographic indices that identify patients of socioeconomic (SES) disadvantage can predict poorer heart graft survival. Methods: We studied 34,584 adult heart transplant recipients from 2004 to 2020 using OPTN database. Established and modern SES indices—including the Agency for Healthcare Research and Quality index (AHRQ), the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), Social Deprivation Index (SDI), and Crime Risk index—were evaluated. We performed survival analysis using Kaplan-Meier, univariable and multivariable Cox regression. Penalized LASSO algorithm was used during model development for variable selection among large number of patient characteristics (e.g., recipient and donor biological factors and comorbidities) related to heart transplantation. Results: On average, the worst level of disadvantage across different SES indices resulted in a 20% increased risk of graft failure (Table 1A). After accounting for the recipient and donor biological factors and comorbidities, the recipients' indices remained statistically significant. Non-white patients (HR:1.10, p<0.001), no private insurance (HR:1.19,p<0.001), and education less than college (HR:1.09,p=0.006) were also statistically significant . Donor SES indices had numerically higher hazard ratios, without statistical significance (Table 1B). Conclusions: Recipients access to health care and nonadherence may stem from low health literacy, limited social support, and financial burden. Further efforts should be taken to counsel patients with socioeconomic disadvantages to improve heart transplant outcomes.