Neighborhood Socioeconomic Deprivation and Outcomes Following Heart Allograft Transplantation in Adults With Congenital Heart Disease

BACKGROUND Socioeconomic disparities in the incidence and management of congenital heart disease (CHD) are well recognized. While neighborhood socioeconomic deprivation has been previously linked with inferior outcomes following heart transplantation (HT) among general adult cohorts, the impact of such disadvantage on outcomes among adult CHD (ACHD) patients listed for transplant remains unknown. OBJECTIVES The authors sought to elucidate the association of neighborhood socioeconomic disadvantage with waitlist and survival outcomes among ACHD HT candidates. METHODS All ACHD patients enrolled in the isolated HT waitlist from 2004 to 2023 were identified within the Organ Procurement and Transplantation Network. Socioeconomic disadvantage was quantified using the Area Deprivation Index. Patients with scores in the highest quintile were considered most deprived (others: less deprived). Survival was assessed using Kaplan-Meier and Cox proportional hazard models. To assess waitlist outcomes, we performed a Fine and Gray competing risk regression. RESULTS Of 1,830 ACHD patients, 366 (20%) were most deprived. Most deprived was of similar age, sex, and race, but more often publicly insured, compared to less deprived. Among transplant recipients, following risk adjustment, most deprived was associated with comparable mortality hazard at 1 (HR: 0.74; 95% CI: 0.48-1.14) and 5 years (HR: 0.91; 95% CI: 0.67-1.24). Among waitlisted candidates, competing risk analysis showed that most deprived faced similar likelihood of mortality or clinical deterioration (HR: 1.19; 95% CI: 0.84-1.68). CONCLUSIONS Among ACHD patients, greater neighborhood socioeconomic disadvantage was not linked with differential HT outcomes. In contrast to other populations, the multidisciplinary care and close follow-up ACHD patients receive may mitigate the negative impact of community disadvantage. (JACC Adv. 2025;4:101720) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).