The influence of socioeconomic deprivation on outcomes in pancreas transplantation in England: Registry data analysis

Abstract

Socioeconomic deprivation is associated with poorer outcomes in chronic diseases. The aim of this study was to investigate the effect of socioeconomic deprivation on outcomes following pancreas transplantation among patients transplanted in England. We included all 1270 pancreas recipients transplanted between 2004 and 2012. We used the English Index of Multiple Deprivation (EIMD) score to assess the influence of socioeconomic deprivation on patient and pancreas graft survival. Higher scores mean higher deprivation status. Median EIMD score was 18.8, 17.7, and 18.1 in patients who received simultaneous pancreas and kidney (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA), respectively (P =.56). Pancreas graft (censored for death) survival was dependent on the donor age (P =.08), cold ischemic time (CIT; P =.0001), the type of pancreas graft (SPK vs. PAK or PTA, P =.0001), and EIMD score (P =.02). The 5-year pancreas graft survival of the most deprived patient quartile was 62% compared to 75% among the least deprived (P =.013), and it was especially evident in the SPK group. EIMD score also correlated with patient survival (P =.05). When looking at the impact of individual domains of deprivation, we determined that “Environment” (P =.037) and “Health and Disability” (P =.035) domains had significant impact on pancreas graft survival. Socioeconomic deprivation, as expressed by the EIMD is an independent factor for pancreas graft and patient survival.