Association of community distress and risk of adverse events on the lung transplant waitlist

Background: Socioeconomic disparities in lung transplantation outcomes have been well described, but little is known about the impact of community-level disparities amongst waitlisted patients. This study examines the relationship between community-level socioeconomic advantage, measured by the Distressed Communities Index (DCI), and the risk of adverse waitlist events, defined as waitlist removal for death or clinical deterioration. Methods: The Scientific Registry of Transplant Recipients was used to retrospectively review 13,792 adult lung transplantation candidates listed between 2016 and 2020. Each patient was associated with a composite DCI score based on education, housing vacancy, unemployment, poverty, median income, and changes in employment and establishments. Clinical data were paired with socioeconomic data using zip codes. Statistical analysis was conducted using descriptive statistics and logistic regression methods. Results: No difference in risk of adverse waitlist events was identified across DCI score quintiles after adjustment. Compared to the least socioeconomically distressed lung transplant waitlist patients, the most distressed patients were more likely to be female (47.77% vs 39.22%), non-White (26.08% vs 10.18%), younger (55.97 vs 58.67), publicly insured (60.43% vs 50.45%), and not complete college education (78.06% vs 56.42%), all p < 0.0001. Conclusions: No difference was found in the risk of adverse events on the lung transplantation waitlist between different composite community distress quintiles. Future research needs to elucidate the effects of disparities present prior to listing for lung transplantation.