Socioeconomic Status a Risk Factor in Child Heart Transplant
Children from lower socioeconomic groups more than twice as likely to have graft failure
WEDNESDAY, April 8 (HealthDay News) -- Children from lower socioeconomic groups are at greater risk for graft failure following a heart transplant than children from higher socioeconomic groups, according to a study published online April 7 in Circulation: Heart Failure.
Tajinder P. Singh, M.D., of Children's Hospital Boston and Harvard Medical School, and colleagues used the U.S. Census 2000 database to calculate a composite socioeconomic score for 135 pediatric patients who each had a first heart transplant at Children's Hospital Boston between 1991 and 2005. The researchers used Cox proportional hazards models to determine risk of graft failure as evidenced by death or re-transplant in the lowest one-third socioeconomic group compared to the higher two-thirds socioeconomic group.
Graft failure occurred in a total of 46 transplant recipients, with 40 deaths and six re-transplants, the researchers report. Low socioeconomic status was associated with higher graft failure (hazard ratio 2.4) as was non-white race (hazard ratio 2.7). The reasons for the disparity were not determined by the analysis but could have resulted from later presentation with symptoms in the low socioeconomic patients or more utilization of follow-up medical services by the high socioeconomic patients, the authors suggest.
"In conclusion, this study demonstrates association of low socioeconomic position with higher risk of graft failure among pediatric heart transplant recipients. These findings need to be confirmed in larger, multi-center cohorts and in different geographic regions with different racial/ethnic mix. Interventions directed at low socioeconomic group patients may improve post-transplant outcomes," Singh and colleagues write.