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Socioeconomics affect post-liver transplant medication adherence in children
CHICAGO — Results form a study on socioeconomic effects on medication on adherence in pediatric patients who underwent liver transplantation revealed that community deprivation and black race regardless of deprivation correlated with nonadherence, according to a presentation at NASPGHAN 2019.
“Where we live has a significant impact on our health, yet little is understood about how neighborhood context impacts the outcomes of liver transplantation,” Sharad Wadhwani, MD, MPH, from the Cincinnati Children’s Hospital Medical Center in Ohio, said during his presentation. “We sought to understand the relationship between community characteristics and self-management capabilities.”
According to Wadhwani, data estimates that up to 53% of adolescent liver transplant recipients are nonadherent with their medication. To explore factors related to nonadherence, he and his colleagues reviewed data from participants enrolled in the MALT clinical trial.
They used the Medication Level Variability Index (MLVI) with a cut-off of 2.5 as a biomarker for adherence. The 7-year multicenter study comprised 320 pediatric liver transplant recipients, 271 of whom had available “deprivation measurements.”
Wadhwani and colleagues observed a 5% increase in MLVI for each 0.1 increase in deprivation index (95% CI, –1% to –11%). Nearly a quarter (23.5%) of patients in the top quartile of the deprivation index had an MLVI of 2.5 or higher compared with 11.8% in the remaining three quartiles (P = .018).
Additionally, black children were more likely to have high MLVI measurements compared with other races before (adjusted OR = 4.2; 95% CI, 1.8-10.6) and after adjusting for deprivation (aOR = 4; 95% CI, 1.7-10.6).
“There is a threshold after which neighborhood deprivation is associated with nonadherence,” Wadhwani said. “These data suggest that the impact of neighborhood socioeconomic status on poor outcome in chronic disease may be due, in part, to medication adherence.”
Wadhwani concluded his presentation stating that efforts to deliver more equitable care and improve adherence need to consider the impact of neighborhood context. – by Talitha Bennett
Reference:
Wadhwani S, et al. Abstract 222. Presented at: NASPGHAN; October 18-19, 2019; Chicago.
Disclosures: Wadhwani reports funding from NIH/NDDK R01 DK080740 and NIH/NIDDK T32DK00727-24 grant, AASLD Advanced/Transplant Hepatology Award, Sherrod Family Fund from Cincinnati Children’s, and Arnold W. Strauss Fellow Award from Cincinnati Children’s.