Previously submitted to: JMIR mHealth and uHealth (no longer under consideration since Dec 11, 2022)
Date Submitted: Nov 18, 2022
Open Peer Review Period: Nov 18, 2022 - Dec 11, 2022
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Effects of Recipient Education Disparity on Living Kidney Transplant Outcomes in the United States from 2005 to 2020
ABSTRACT
Background:
Previous studies have shown that the level of education is associated with the prognosis of cadaveric kidney transplant recipients. However, it is unclear whether education affects the prognosis of living kidney transplant recipients. In addition, it remains to be determined whether the uneven distribution of education levels consistently affects the prognosis of LDKT recipients across ethnic groups.
Objective:
The outcomes of LDKT recipients with different levels of education were compared to verify the difference, and the relationship between education level and prognostic risk of LDKT recipients in different races was evaluated.
Methods:
We conducted a retrospective study of adult recipients who received their first living single kidney transplant from 2005 to 2020. The LDKT recipients were divided into low and high education groups, and the transplant outcomes including graft survival, patient survival, and death-censored graft survival, in the LDKT recipients between these groups were analyzed and compared.
Results:
The graft and patient survival rates in the high education group were better than those in the low education group (P <.001). As compared to the high education group, the risk of graft failure and mortality increased by 11% [hazard ratio (HR), 1.11 (1.06 to 1.15)] and 7% [(HR), 1.07 (1.02 to 1.13)] in the low education group, respectively. The subgroup analysis showed that White, Black, and Asian ethnic groups showed a similar trend. However, there was no significant difference in the graft and patient survival rates among Hispanic groups between the two education groups (P = 0.38 and P = 0.41, respectively). The adjusted risk of graft failure in the low education group decreased 7% [adjusted hazard ratio (aHR), 0.93 (0.88 to 0.98)] in White recipients, increased 19% [(aHR), 1.19 (1.09 to 1.31)] and 31% [(aHR), 1.31 (1.02 to 1.69)] in Black and Asian, respectively.
Conclusions:
This study showed that the high education level had better transplant outcomes in LDKT recipients, and these differences in transplant outcomes were mainly found in white, black, and Asian recipients.
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