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Socioeconomic Deprivation and Survival After Heart Transplantation in England: An Analysis of the United Kingdom Transplant Registry.

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Evans, Jonathan DW 
Caleyachetty, Rishi 
Di Angelantonio, Emanuele  ORCID logo
Lewis, Clive 


BACKGROUND: Socioeconomic deprivation (SED) is associated with shorter survival across a range of cardiovascular and noncardiovascular diseases. The association of SED with survival after heart transplantation in England, where there is universal healthcare provision, is unknown. METHODS AND RESULTS: Long-term follow-up data were obtained for all patients in England who underwent heart transplantation between 1995 and 2014. We used the United Kingdom Index of Multiple Deprivation (UK IMD), a neighborhood level measure of SED, to estimate the relative degree of deprivation for each recipient. Cox proportional hazard models were used to examine the association between SED and overall survival and conditional survival (dependant on survival at 1 year after transplantation) during follow-up. Models were stratified by transplant center and adjusted for donor and recipient age and sex, ethnicity, serum creatinine, diabetes mellitus, and heart failure cause. A total of 2384 patients underwent heart transplantation. There were 1101 deaths during 17 040 patient-year follow-up. Median overall survival was 12.6 years, and conditional survival was 15.6 years. Comparing the most deprived with the least deprived quintile, adjusted hazard ratios for all-cause mortality were 1.27 (1.04-1.55; P=0.021) and 1.59 (1.22-2.09; P=0.001) in the overall and conditional models, respectively. Median overall survival and conditional survival were 3.4 years shorter in the most deprived quintile than in the least deprived. CONCLUSIONS: Higher SED is associated with shorter survival in heart transplant recipients in England and should be considered when comparing outcomes between centers. Future research should seek to identify modifiable mediators of this association.



England, heart failure, heart transplantation, proportional hazards models, Adult, Age Factors, Comorbidity, England, Female, Health Status Disparities, Healthcare Disparities, Heart Failure, Heart Transplantation, Humans, Linear Models, Logistic Models, Male, Middle Aged, Multivariate Analysis, Poverty, Proportional Hazards Models, Registries, Risk Assessment, Risk Factors, Sex Factors, Time Factors, Tissue and Organ Procurement, Treatment Outcome

Journal Title

Circ Cardiovasc Qual Outcomes

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Ovid Technologies (Wolters Kluwer Health)
Medical Research Council (MR/L003120/1)
Medical Research Council (G0800270)
British Heart Foundation (None)
British Heart Foundation (None)
Medical Research Council (G0800270/1)
No direct funding was provided for the conduct of this study. JE completed part of this work as part of an academic clinical fellowship, where he spent time at the University of Cambridge, Cardiovascular Epidemiology Unit receiving training on research methods, supported by SK and EDA. The Cardiovascular Epidemiology Unit is funded by the UK Medical Research Council (G0800270), British Heart Foundation (SP/09/002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, and UK National Institute for Health Research Cambridge Biomedical Research Centre.