Is There a Socioeconomic Gradient for the Risk of Acute Rejection and Other Adverse Outcomes in Canadian Kidney Transplant Recipients?
Bibliographic record
Abstract
Background: Socioeconomic status (SES) is an important determinant of health. Many studies from the United States have shown low SES to be a risk factor for poorer graft and patient survival among kidney transplant recipients. However, the way SES contributes to recipient outcomes within a universal health care system, such as Canada, has not been well studied. Purpose: To determine the presence, or absence of a socioeconomic gradient for kidney transplant outcomes (particularly acute rejection) among kidney transplant recipients at a single, Canadian centre. Methods: This is a retrospective cohort study of all patients who received a kidney transplant at Toronto General Hospital between 1 Jan 2001 and 31 Dec 2010. Neighbourhood-based measures of income (as a surrogate for SES) were determined by linking patients' postal codes with 2001 and 2006 Canadian Census data. Annual neighbourhood income was categorized into quartiles (Q1: < $44,440; Q2: $44,440 to $63,099; Q3: $63,100 to $82,909; Q4: ≥ $82,910). The primary outcome was biopsy proven acute rejection (BPAR) with graft failure and patient mortality as secondary outcomes. Multivariable Cox proportional hazards models were used to estimate adjusted relative hazards for all time-to-event endpoints. Results: A total of 986 patients were included in the analysis. There were 164 BPAR events over 4,205.3 person-years of follow-up (median follow-up 3.3 years). There was no association between income quartile and the risk of BPAR (hazard ratios or HR 0.92 [95% CI: 0.59, 1.44], 0.94 [95% CI: 0.60, 1.45], and 0.91 [95% CI: 0.59, 1.41] for Q1, Q2, and Q3, with Q4 as the referent group). The risk of death with graft function was strongly associated with income quartile (HR 3.60 [95% CI: 1.64, 7.88], 2.68 [95% CI: 1.20, 5.99], and 2.81 [95% CI: 1.23, 6.43]) but not death-censored graft failure (HR 0.96 [95% CI: 0.50, 1.85], 1.07 [95% CI: 0.56, 2.05], and 1.36 [95% CI: 0.73, 2.54]). Conclusions: Lower SES (as measured by neighbourhood income status) is not associated with an increased risk of BPAR or death-censored graft failure among Canadian kidney transplant recipients. Unrestricted access to medical care and immunosuppressive medications in the setting of a universal health care system may partially explain these findings. The factors leading to an increased risk of mortality in patients with lower SES require further study. DISCLOSURES:Kim, S.: Grant/Research Support, Astellas Pharma Canada, Novartis Pharma Canada, Genzyme Canada.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".