Children Of Lower Socioeconomic Status Fare Worse After Heart Transplant
Children from lower socioeconomic neighborhoods who had a heart transplant were more likely than those of a higher socioeconomic status to die or need another heart transplant, researchers report in Circulation: Heart Failure.
“The new finding is the first time that low socioeconomic position has been associated with a higher risk of graft failure defined in this study as either death or needing a second transplant after a first heart transplant,” said Tajinder P. Singh, M.D., lead author of the study and a transplant cardiologist at Children’s Hospital Boston and Harvard Medical School.
Researchers analyzed 135 patients — 58 percent boys, median age 8.4 years — who received their first heart transplant at Children’s Hospital Boston between 1991–2005. Among them, 110 were white (82 percent) and 18 percent non-white (10 black; eight Hispanic; and seven from other racial groups).
Researchers compared 45 children in the lowest socioeconomic group to the remaining two-thirds (controls). The two groups were similar in age, gender, diagnosis and year of transplant. Overall, 40 children died and six underwent a re-transplant during the study period. Nine of these deaths occurred during the initial hospitalization for heart transplant. Among those who survived the initial hospital stay, during a median follow-up period of six years, 31 deaths and six re-transplants occurred.
* Children from low socioeconomic neighborhoods were 2.4 times more likely to have graft failure after transplant when compared to the controls.
* Minority children were 2.7 times more likely to suffer graft failure when compared to whites.
* Among 9 early deaths during transplant hospitalization, 6 deaths, or 13.3 percent, occurred in the lower socioeconomic group compared to three deaths, or 3.3 percent, in the higher socioeconomic group.
* Survival of the transplanted heart was significantly shorter in the low socioeconomic group at one year, three years, and five years post-transplantation.
The time to death or re-transplantation was significantly shorter for children who came from a lower socioeconomic group. These children also had a higher likelihood of rejection in their transplanted hearts, researchers said.
“Low socioeconomic status and non-white race appear to be independent risk factors for worse outcomes,” said Singh, who is also assistant professor of pediatrics at Harvard Medical School.
Singh said low socioeconomic children may have been sicker when they came to the heart transplant center. “They also may have difficulty using available resources from the medical community, which may reflect the lack of resources available to them at a personal and family level.”
All patients in the study had medical insurance, had access to medical personnel and availability of medications during their clinical course, researchers said.
The researchers used a sophisticated statistical technique to analyze six different socioeconomic factors, a previously validated way to look at neighborhood socioeconomic data but new for transplant population. They used U.S. Census data to focus on block groups, the neighborhood of a person’s residence, and the smallest geographic census unit for which socioeconomic data is available. The six components were combined into a single score.
Lower socioeconomic status reflected:
• lower median income;
• lower median value of housing;
• fewer adults with high-school and college education;
• fewer adults in managerial, professional or executive positions; and
• fewer households with rental, interest or dividends as the source of their income.
These results should be considered preliminary and need to be confirmed in larger population groups, Singh said.
“Improving the outcomes of heart transplantation in the lower socioeconomic status children requires new strategies and interventions for patients, families and the medical system,” Singh said.