Impact of Patient- and Community-Level Socioeconomic Status on Timing of Waitlist Addition in Hispanic Kidney Transplant Candidates

Background: Socioeconomic factors contribute to disparities that Hispanic patients face when accessing kidney transplant care, though the relative influence of community-versus patient-level socioeconomic status is unclear.We evaluated the relationship between community and patient-level socioeconomic profiles when considering timing of kidney transplant waitlist addition in this ethnic cohort.Methods: We studied all Hispanic patients >18 years old listed at our center for a kidney-only transplant between 2015-2024.Patients were considered by socioeconomic status of their zip code of residence defined by the Distressed Communities Index (DCI).Patient-level socioeconomic well-being was designated by education level and employment status.Logistic regression analyses assessed the relationship between community-and patient-level socioeconomic well-being and odds of preemptive waitlist addition.Results: We studied 4,260 Hispanic patients of whom more than two-thirds resided in zip codes classified as distressed (DCI 80-100) or at-risk of distress (DCI 60-80), while 11% were from prosperous communities (DCI 0-20).Residence in more distressed zip codes was associated with more diabetes and unemployment, and lower rates of college-level education and private insurance (Table 1).Progressive levels of community distress predicted lower odds of preemptive waitlist addition, with those from the most distressed zip codes half as likely to experience preemptive listing compared to those from prosperous communities (Figure 1).Considering patient-level socioeconomic status, 16% had both college education and employment, 37% had either college education or employment, and 47% had neither.Across all communities, higher education and/or employment was associated with a greater odds of preemptive listing (Figure 2).Higher patientlevel socioeconomic status markedly dampened the influence of community-level distress on likelihood of preemptive waitlist addition (Table 2).Conclusions: Residence of Hispanic patients in zip codes with greater socioeconomic distress predicts later kidney transplant referral.However, elevated patient-level socioeconomic status substantially mitigates the deleterious impact that community distress has upon preemptive waitlist addition.These data suggest a prominent role for patient health literacy and self-advocacy in dictating timely access to kidney transplant care in the Hispanic community.