A. J. Cole1, P. K. Baliga1, D. J. Taber1 1Medical University Of South Carolina,Charleston, Sc, USA
Introduction: Research analyzing the effect socioeconomic status (SES) has on renal transplant outcomes has demonstrated conflicting results. However, recent studies demonstrate that certain patient-reported outcomes (PROs), such as depression, medication non-adherence, health literacy, social support, and self-efficacy can influence clinical outcomes in renal transplant recipients. Our objectives were to examine the effect SES has on PROs, and determine if there is an association between SES, patient-reported outcomes, and healthcare utilization.
Methods: Post-hoc analysis of 52 patients enrolled in an ongoing prospective trial aimed at improving cardiovascular disease risk factor control in renal transplant recipients. As part of the study, at baseline, patients completed detailed surveys assessing SES and PROs. Patients were divided into low and high SES cohorts based on income, education, marital status, insurance, and employment. All patients were given 12 self-reported surveys in the domains of medication-related issues, self-care and knowledge, psychosocial issues, and healthcare. Analyses included the associations between 12 PRO surveys, SES measures, and healthcare utilization, including the rate of hospitalizations, ED visits and clinic visits that occurred between the date of transplant and enrollment in the trial.
Results: The low SES cohort (n=16, 30.8%) experienced more severe depression (5.75 vs 3.0, p=0.022), higher rates of inadequate health literacy (3.42 vs 1.68, p=0.022) and perceived stress (2.743 vs 3.266, p=0.027), along with significantly less self-efficacy (6.971 vs 8.214, p=0.006) and social support (3.86 vs 4.408, p=0.012; see Figure 1). Low SES was associated with a 60% higher rate of hospitalization and 90% higher rate of ED visits per patient-year. Medication non-adherence was also associated with more hospitalizations and ED visits.
Conclusion: This analysis demonstrates that low SES was significantly associated with negative PROs, including depression, health literacy, social support, stress, and self-efficacy. Further, low SES and medication non-adherence was associated with higher rates of healthcare utilization.
