Racial Disparities in Pediatric Intestinal Transplant Wait-List Times Are Not Explained by Socioeconomic Measures.

BACKGROUND

Racially minoritized children with intestinal failure are less likely to undergo intestinal transplant and more than twice as likely to die without one. Socioeconomic factors may contribute to disparities in transplant receipt and healthcare utilization, but their role remains poorly understood.

METHODS

We included intestinal transplant recipients (< 18 years) listed in the Scientific Registry of Transplant Recipients (2002-2021) with hospitalizations recorded in the Pediatric Health Information System (2004-2023). Race was categorized as White or Non-White. Neighborhood income was determined using patient zip code-level median household income and categorized by federal poverty thresholds. Primary outcomes were wait-list time, annual inpatient bed-days, risk of hospitalization, and 30-day readmission post-transplant. Cox proportional hazards models, generalized linear mixed effects models, and logistic regression were used, adjusting for neighborhood income and insurance.

RESULTS

Among 42 children (median age at listing 1 year, IQR: [1, 4]), 21% were non-White, 48% had public insurance, and 52% lived in low-income neighborhoods. The median wait-list time was 486 days (IQR: [232, 650]). Non-White children had longer wait-list times than White children (1034 vs. 442 days, HR: 0.38, 95% CI: 0.17, 0.88, p = 0.02), persisting after adjustment (HR 0.27, 95% CI 0.11, 0.71, p = 0.008). No racial differences were observed in inpatient bed days, hospitalization risk, or 30-day readmission.

CONCLUSION

Racial disparities in intestinal transplant wait-list times persisted after adjustment for socioeconomic measures, suggesting that barriers beyond income and insurance contribute to inequities in timely transplant. Further research should clarify where in the process disparities arise to inform strategies that ensure more equitable care.