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Influence of Spatial Topography of Poverty on Hospitalization Status Following Renal Transplantation

Afshar, Yama (2013)
Master's Thesis (47 pages)
Committee Chair / Thesis Adviser: Patzer, Rachel Elizabeth
Committee Members:
Research Fields: Health Sciences, General; Health Sciences, Public Health
Partnering Agencies: Does not apply (no collaborating organization)
Keywords: Spatial Topography; Poverty; Hospitalization; Renal; Transplant
Program: Rollins School of Public Health, Epidemiology (Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/dwgw7



Background: Previous studies suggest that neighborhood poverty contributes to disparities among patients with End Stage Renal Disease (ESRD). It is unclear whether spatial topography of poverty across geographical regions in the United States influences hospitalization status following renal transplantation.

Methods: We examined 18,736 adult (18+), first-time, kidney-only transplant recipients from the United Network for Organ Sharing database between 2004-2005. Both adjusted and unadjusted logistic regression models were used to explore the relationship between a previously described index and whether a patient was hospitalized approximately 1.5 years (620 days) post renal transplantation. Patients missing data on the exposure (n=428)--spatial topography of poverty--or outcome (n=501)--hospitalization status--were excluded from the analysis.

Results: In multivariable models adjusted for age, race, sex, BMI, diabetes, hypertension, donor type, primary form of payment, HLA match, and serum albumin at registration, we found that the odds of hospitalization among patients living in counties with high poverty rates that were categorized as spatial outliers was 1.14 (95% CI 1.01-1.28, p = 0.01) times that of patients living in counties with poverty rates within 1 standard deviation of the mean county poverty rate in the United States (14.2%) that were categorized as neither spatial outliers nor part of a concentrated cluster.

Conclusions: Our analysis demonstrates that the number of hospitalizations in a county is influenced by the economic prosperity of its surrounding counties in addition to its own poverty rate.

Table of Contents

Table of Contents
  • Chapter I: Background - 1
  • Chapter II: Manuscript - 8
    • Abstract - 8
    • Introduction - 9
    • Methods - 10
    • Results - 13
    • Discussion - 15
    • References - 20
    • Tables - 22
    • Figures - 29
  • Chapter III: Public Health Implications and Possible Future Directions - 31
    • Appendices - 32


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