Social determinants of health tied to long-term employment after heart transplant
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A database analysis showed 22% of heart transplant recipients who survived to 1 year and received follow-up were employed full time at 1 year and nearly 33% were employed at 2 years after transplant.
In a retrospective analysis of more than 10,000 heart transplant recipients who survived to 1 year with follow-up, researchers also found that employment at the time of listing or transplantation was strongly associated with employment after surgery. Additionally, social determinants of health, including race and ethnicity, sex, insurance status and education level were also all significantly related to employment after surgery.
Data were derived from Cramer CL, et al. J Heart Lung Transplant. 2023;doi:10.1016/j.healun.2022.12.025.
“Employment following solid organ transplant is a challenge for patients and can be used as metric of posttransplant functional status,” Leora T. Yarboro, MD, associate professor of surgery at the University of Virginia, and colleagues wrote in the Journal of Heart and Lung Transplantation. “The ability to find gainful employment following heart transplantation can be challenging given the complex interplay of pretransplant functional status due to heart failure, posttransplant condition, and social determinants of health. While it has been shown that employment status prior to transplantation provides a posttransplant survival benefit, limited data exists regarding employment after heart transplantation.”
In a retrospective study, Yarboro and colleagues analyzed data from 10,132 adults in the United Network for Organ Sharing database who underwent a single-organ heart transplant between 2007 and 2016 who survived to 1 year with follow-up. Researchers stratified patients by employment status at 1 year after transplant and evaluated mortality risk based on employment status.
Within the cohort, 22% were employed 1 year after transplant. The employment rate of survivors increased to 32.9% by year 2.
Employed patients were more likely to be white as opposed to Asian, Black or Hispanic (70.8% vs. 60.4%; P < .01), to be men as opposed to women (79.6% vs. 70.7%; P < .01), to have held a job at the time of listing or transplant (37.6% vs. 7.6%; P < .01) and to have had private insurance (79.1% vs. 49.5%; P < .01).
Additionally, researchers found that several characteristics were independently associated with employment, including age, employment status at time of listing or transplant, race and ethnicity, sex, insurance status, education and postoperative complications.
Among the 14% of patients who were employed before their transplant, 58% were working at 1 year.
Postoperative complications, including postoperative dialysis (HR = 0.4; 95% CI, 0.4-0.5; P < .01) and postoperative stroke (HR = 0.5; 95% CI, 0.4-0.7; P < .01), were found to be inversely associated with employment, according to the researchers.
Patients who were employed at 1 year after transplant were at 27% decreased risk for mortality compared with patients who were unemployed at 1 year (HR = 0.734; 95% CI, 0.619-0.858; P = .0001).
“There are several factors related to social determinants of health — race and ethnicity, gender, insurance status and education level — that influence time to employment after heart transplantation,” the researchers wrote. “Social determinants of health were also associated with a lower probability of gaining employment after transplant. These results should prompt stakeholders to screen for social determinants of health and direct resources to those at risk prior to transplantation.”
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