Kidney transplant recipients from socioeconomically disadvantaged neighbourhoods face important inequalities in cancer risk and outcomes, according to a large US registry study linking transplant and cancer data over nearly two decades.
Socioeconomic Status And Cancer Risk
Cancer is a leading cause of death among kidney transplant recipients, who already have a higher cancer risk than the general population due to long-term immunosuppression. Researchers analysed data from 168,028 adults who received their first kidney transplant in the United States between 2000 and 2019. Neighbourhood socioeconomic status was measured using the Yost index, which incorporates income, education, housing, and employment and categorises areas into five quintiles from most disadvantaged to most advantaged.
Over a median follow-up period, 11,146 cancers were diagnosed, corresponding to an overall incidence of 12.3 per 1,000 person-years. Overall cancer incidence did not differ across neighbourhood socioeconomic groups. However, clear differences emerged for specific cancer types.
Recipients living in the most disadvantaged neighbourhoods had a significantly higher incidence of lung cancer compared with those in the most advantaged areas. After adjustment, lung cancer rates were 44% higher in the lowest Yost quintile. In contrast, prostate cancer incidence was 24% lower among men from the most disadvantaged neighbourhoods, a finding that may reflect differences in screening practices rather than true biological risk.
Stage At Diagnosis Differences
The study also examined whether neighbourhood disadvantage was associated with cancer stage at diagnosis. While no consistent patterns were seen across most cancers, melanoma stood out. Kidney transplant recipients from more disadvantaged areas who developed melanoma were more likely to be diagnosed at a regional or distant stage rather than at an early, localised stage. Late-stage presentation of melanoma is clinically important, as it is strongly associated with poorer survival.
Higher Mortality After Cancer Diagnosis
After a cancer diagnosis, neighbourhood disadvantage was linked to worse outcomes. Cancer-specific mortality was 18% higher among transplant recipients living in the most disadvantaged areas compared with those in the most advantaged neighbourhoods. Although this pattern was not statistically significant for individual cancer types, the overall trend suggests meaningful disparities in cancer treatment, follow-up care, or broader health support.
The researchers conclude that while overall cancer incidence among kidney transplant recipients does not vary by neighbourhood socioeconomic status, substantial inequalities exist for certain cancers, stage at diagnosis, and survival.
Reference
Harn-Yue N et al. The association between neighborhood socioeconomic status and posttransplant cancer outcomes among kidney transplant recipients in the united states. Kidney360. 2025; 10.34067/KID.0000000979.
