COVID-19 mortality among kidney transplant candidates is strongly associated with social determinants of health.

The COVID-19 pandemic has affected all portions of the global population. However many factors have been shown to be particularly associated with COVID-19 mortality including demographic characteristics, behavior, comorbidities and social conditions. Kidney transplant candidates may be particularly vulnerable to COVID-19 as many are dialysis-dependent and have comorbid conditions. We examined factors associated with COVID-19 mortality among kidney transplant candidates from the national Scientific Registry of Transplant Recipients from March 1st -December 1st ,2020. We evaluated crude rates and multivariable incident rate ratios(IRR) of COVID-19 mortality. There were 131,659 candidates during the study period with 3,534 all-cause deaths and 384 denoted a COVID-19 cause (5.00/1000 person years). Factors associated with increased COVID-19 mortality included increased age, males, higher body mass index and diabetes. In addition, Blacks (IRR=1.96,95%C.I.1.43-2.69) and Hispanics(IRR=3.38,95%C.I.2.46-4.66) had higher COVID-19 mortality relative to Whites. Patients with lower educational attainment, high school or less (IRR=1.93,95%C.I.1.19-3.12,relative to post-graduate), Medicaid insurance (IRR=1.73,95%C.I.1.26-2.39,relative to private), residence in most distressed neighborhoods (5th quintile IRR=1.93,95%C.I.1.28-2.90,relative to 1st quintile) and most urban and most rural had higher adjusted rates of COVID-19 mortality. Among kidney transplant candidates in the US, social determinants of health in addition to demographic and clinical factors are significantly associated with COVID-19 mortality.