Socioeconomic status and heart transplant outcomes

Here is another sad case of disparity among heart transplant recipients. It seems that children of low socioeconomic status tend to have worse health outcomes even after a heart transplant, according to Boston researchers.

The study followed up 135 pediatric patients who received their first heart transplant at Children’s Hospital Boston from 1991-2005. The demographic profile of the study group are:

• 82% were white (110)
• 18 % were non whites (10 black; eight Hispanic; and seven from other racial groups).
• 58% were boys; 42% were girls
• median age is 8.4 years

The researchers grouped the patients based on their socioeconomic status and followed up their outcomes after heart transplantation. One-third (45) of the patients were classified as “low socioeconomic group” and compared to the remaining two-thirds.  The two groups were similar demographically.

The findings show that

• 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 low socioeconomic group also had a higher likelihood of rejection and had a shorter time to death or retransplantation. The study indicates that “low socioeconomic status and non-white race appear to be independent risk factors for worse outcomes.”

Looking closely as to what “lower socioenconomic status” means based on six socioeconomic factors, the following can be used as indicators:

• 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.

The reasons for this disparity in health outcomes due to socioeconomic status are not clear but it may be due to difficulty in using medical resources. Because all patients had health insurance coverage and equal access to medical resources, the causes of the difficulty could be at the family and personal level.

Last year, there was another post highlighting the disparity in organ transplantation in relation to ethnicity. That study showed that non-white children are more likely to die while waiting for a heart donor. Clearly, there is a need to delve deeper into the causes of these disparities.  Because I believe that each child deserves a fair chance regardless of skin color or bank account balance.

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