Increasing Distressed Communities Index Scores are Associated with Failure to Progress to Lung Transplantation

D. Satija¹, D. A.. Gouchoe², S. S. Scott¹, A. Vijayakumar³, M. C. Henn¹, K. Choi¹, J. Rosenheck¹, B. Small¹, S. Kirkby¹, V. Ramsammy¹, D. Nunley¹, N. A. Mokadam¹, B. A. Whitson¹, A. M. Ganapathi^4
1The Ohio State University Wexner Medical Center, Columbus, Ohio ²COPPER Lab, The Ohio State University Wexner Medical Center, Columbus, Ohio ³Ohio State, Columbus, Ohio ⁴The Ohio State University, Columbus, Ohio

Purpose: Socioeconomic disparities in lung transplant have been studied, however primarily in transplant recipients. These disparities have not been well examined with regards to progression to listing and eventual lung transplant. The aim was to study the association of socioeconomic status with time to listing and eventual transplantation.

Methods: A single-center retrospective review of patients undergoing lung transplantation was conducted from 1 January, 2013 to 6 June 2021. The distressed communities index (DCI), a zip code-based metric, was used to classify socioeconomic status and patients were categorized into two groups: DCI < 60 (prosperous, comfortable, and mid-tier) and DCI>60 (at-risk to distressed). Comparative statistics were used to compare referral to waitlist time (RL), referral to transplant time (RT) and waitlist to transplant time (WT). Furthermore, comparison of DCI between all referrals based on their progression to listing and subsequent transplant was conducted. Finally, a Spearman rank correlation coefficient was used to determine the association of DCI and proceeding to lung transplantation.

Results: 422 patients were identified, with 238 in the DCI < 60 group and 183 in the DCI>60 group. Patients in the DCI>60 group had significantly higher RL times (median [M]: 219.0 days, interquartile range [IQR]: 174.5 days) compared to the DCI < 60 group (M: 178.0 days, IQR: 178.0 days) (Figure 1A, p=0.0116). Those in the DCI>60 group also had significantly higher RT times as well (M: 278.0 days, IQR: 290.0 days) compared to the DCI < 60 group (M: 224.0 days, IQR: 227.5 days) (Figure 1B, p=0.0032). No significant difference was noted in the WT times between the DCI>60 group (M: 25.0 days, IQR: 91.5 days) and the DCI < 60 group (M: 20.0 days, IQR: 44.0 days) (Figure 1C, p=0.1705). Amongst those who were transplanted, listed for transplant and made it from referral to transplant, their DCI was significantly lower than those who weren’t (p=0.0045, p=0.0025, p< 0.0001 respectively). The spearman’s rank correlation coefficient between DCI and transplantation was -0.0615, suggesting a significant negative correlation (p=0.0045).

Conclusion: This single-institution data suggests that as DCI increases, there is a lower probability of transplantation, as well as a longer referral to waitlist as well as transplant times. It is imperative to identify barriers that drive the disparity in referral to waitlist time, as well as referral to transplant time. Transplant centers must develop programs to aid socioeconomically disadvantaged individuals, to more equitably offer this life altering therapy.

Identify the source of the funding for this research project: This project received Division funding. Additionally, BAW is supported through the National Institutes of Health National Heart Lung and Blood Institute grant R01HL143000.