Relating Multidimensional Deprivation Index to Adherence Outcomes in Pediatric Solid Organ Transplant

Abstract

Objective:

Adherence to immunosuppressant medications is critical for positive posttransplant outcomes in pediatric solid organ transplant (SOT) patients. Systemic oppression across economic, health, education, and housing domains can result in barriers to regularly taking immunosuppressant medications posttransplantation, leading to disparate health outcomes for marginalized families. This study evaluates whether the level of deprivation in families’ counties of residence creates barriers to medication adherence among pediatric SOT patients by utilizing a multidimensional index of poverty and variability in immunosuppressant medication values as a measure of adherence.

Method:

Coefficient of variation in immunosuppressant levels of tacrolimus and rapamycin was used as a measure of adherence and was collected from a sample of adolescent SOT patients living in the United States (N = 55, 67% female, 93% White, Mdn_age = 15.3 years) through electronic medical record review. A family’s experience of poverty in their county of residence was determined using the Census Bureau multidimensional deprivation index.

Results:

Living in a county with higher levels of multidimensional deprivation was associated with more variability in levels of immunosuppressant medication for adolescents (β = 1.79, p < .01 tacrolimus; β = 2.23, p < .05 rapamycin).

Conclusions:

Screening for intersecting levels of systemic deprivation (e.g., economic, health, neighborhood, and education) at the county level can inform what resources are needed to support adolescents’ adherence behaviors.

Implications for Impact Statement

This article utilizes a multidimensional index of poverty and variability of immunosuppressant medication as an indicator of adherence to evaluate how social deprivation is related to adherence in adolescent solid organ transplant patients. Recommendations for addressing social determinants of health related to posttransplant care are discussed.

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