December 29, 2025
3 min read
Key takeaways:
- Overall cancer incidence was not significantly associated with neighborhood-level determinants of health.
- Advanced-stage kidney cancer prevalence was greater in more disadvantaged neighborhood quintiles.
Neighborhood-level social determinants of health were associated with varying cancer risks and greater mortality among kidney transplant recipients, according to study results.
Cancer is a leading cause of death for kidney transplant recipients, particularly those living in disadvantaged neighborhoods, according to Yue-Harn Ng, MD, MPH, clinical professor of medicine and director of the transplant fellowship program at University of Washington, and colleagues. However, there is limited data on posttransplant cancer-related outcomes for kidney recipients, the researchers wrote.
Data derived from Ng YH, et al. Kidney360. 2025;doi:10.34067/KID.0000000979.
Yue-Harn Ng
“There is ample data to show that social determinants of health can impact cancer outcomes in the general population but less focus on how they impact posttransplant kidney outcomes and none on cancer-related outcomes,” Ng told Healio.
To assess the effect of neighborhood socioeconomic status on posttransplant cancer outcomes, Ng and colleagues reviewed data from 168,028 first-time kidney transplant recipients (median age, 50 years; 60% men; 48.4% non-Hispanic white) linked to U.S. transplant and cancer registries from 2000 to 2019. Among recipients, 11,146 were diagnosed with posttransplant cancer.
Participants were divided into Yost index quintiles based on neighborhood income, education levels, housing and employment, with quintile 1 being the most disadvantaged neighborhoods and quintile 5 being the least disadvantaged. The researchers then used Poisson regression to compare association of neighborhood status with overall cancer incidence for seven common cancers: colorectum, lung, breast, prostate, kidney, melanoma and non-Hodgkin lymphoma.
Researchers found the most disadvantaged neighborhoods had lower overall cancer incidence compared with the least disadvantaged neighborhoods in the unadjusted model (incidence rate ratio [IRR] = 0.9; 95% CI, 0.85-0.96), but this association lost significance in the adjusted model. Overall cancer incidence was 12.3 per 1,000 person-years, with no major differences across quintiles.
Kidney transplant recipients in the most disadvantaged neighborhoods had higher incidence of lung cancer (adjusted IRR = 1.44; 95% CI, 1.19-1.73) but lower incidence of prostate cancer (adjusted IRR = 0.76; 95% CI, 0.63-0.92). No significant differences were noted in other cancers.
“The lower prostate cancer incidence among [kidney transplant recipients] residing in the most disadvantaged neighborhoods may reflect lower rates of posttransplant screening,” the researchers wrote.
In addition, kidney transplant recipients in disadvantaged neighborhoods were more likely to be diagnosed with advanced-stage melanoma. Advanced-stage kidney cancer prevalence was greater for patients in quintile 1 (adjusted prevalence ratio [aPR] = 1.54; 95% CI, 1.04-2.28), quintile 3 (aPR = 1.5; 95% CI, 1.03-2.19) and quintile 4 (aPR = 1.47; 95% CI, 1.01-2.14) compared with patients in the least disadvantaged neighborhoods.
Furthermore, more disadvantaged neighborhoods were associated with significantly greater cancer-related mortality for all cancers combined (aHR = 1.18; 95% CI, 1.05-1.18) but not for individual cancer types.
“At initial glance, I was a little surprised to see that neighborhood disadvantage was not associated with cancer incidence in the posttransplant population,” Ng told Healio. “However, the kidney transplant population is a uniquely privileged population where they undergo yearly screening for cancer while on the waitlist, which may lead to cancer detection.”
Overall, continued care and screenings are essential posttransplantation, as kidney transplant patients will remain on immunosuppressants, Ng said.
“Caring for a kidney transplant patient does not stop after they receive a transplant,” Ng said. “Kidney transplant recipients from the most disadvantaged neighborhoods are at the highest risk for losing access to posttransplant care and cancer treatment once a diagnosis is established, so it’s important for these individuals to continue to have insurance coverage access beyond the 3 years of Medicare entitlement.”
Future research should explore the long-term impacts of social determinants of health on posttransplant outcomes, according to Ng.
“We would like to see more rigorous studies assessing the impact of [social determinants of health] on long-term kidney transplant outcomes over 10 to 15 years, including allograft and patient survival, and long-term complications such as infections and cancers,” Ng said.
For more information:
Yue-Harn Ng, MD, MPH, can be reached at yharn1@uw.edu.
Ask a clinical question and tap into Healio AI’s knowledge base.
- PubMed, enrolling/recruiting trials, guidelines
- Clinical Guidance, Healio CME, FDA news
- Healio’s exclusive daily news coverage of clinical data
