Does Racial Disparity in Kidney Transplant Waitlisting Persist After Accounting for Social Determinants of Health?

被引:73
|
作者
Ng, Yue-Harn [1 ]
Pankratz, V. Shane [1 ]
Leyva, Yuridia [2 ]
Ford, C. Graham [2 ]
Pleis, John R. [3 ]
Kendall, Kellee [4 ]
Croswell, Emilee [4 ]
Dew, Mary Amanda [5 ]
Shapiro, Ron [6 ]
Switzer, Galen E. [4 ]
Unruh, Mark L. [1 ]
Myaskovsky, Larissa [1 ,2 ]
机构
[1] Univ New Mexico, Dept Med, Div Nephrol, MSC 04-2785, Albuquerque, NM 87131 USA
[2] Univ New Mexico, Ctr Healthcare Equ Kidney Dis CHEK D, Hlth Sci Ctr, Albuquerque, NM 87131 USA
[3] Ctr Dis Control & Prevent, Div Res & Methodol, Natl Ctr Hlth Stat, Hyattsville, MD USA
[4] Univ Pittsburgh, Sch Med, Dept Med, Pittsburgh, PA 15213 USA
[5] Univ Pittsburgh, Sch Med, Dept Psychiat, Pittsburgh, PA USA
[6] Icahn Sch Med, Mt Sinai Recanati Miller Transplantat Inst, New York, NY USA
基金
美国国家卫生研究院;
关键词
PERCEIVED DISCRIMINATION; NEIGHBORHOOD POVERTY; ALLOCATION SYSTEM; RENAL-TRANSPLANT; INSURANCE TYPE; DONOR; DIALYSIS; ACCESS; SUBDISTRIBUTION; MORBIDITY;
D O I
10.1097/TP.0000000000003002
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. African Americans (AA) have lower rates of kidney transplantation (KT) compared with Whites (WH), even after adjusting for demographic and medical factors. In this study, we examined whether the racial disparity in KT waitlisting persists after adjusting for social determinants of health (eg, cultural, psychosocial, and knowledge). Methods. We prospectively followed a cohort of 1055 patients who were evaluated for KT between 3 of 10 to 10 of 12 and followed through 8 of 18. Participants completed a semistructured telephone interview shortly after their first KT evaluation appointment. We used the Wilcoxon rank-sum and Pearson chi-square tests to examine race differences in the baseline characteristics. We then assessed racial differences in the probability of waitlisting while accounting for all predictors using cumulative incidence curves and Fine and Gray proportional subdistribution hazards models. Results. There were significant differences in the baseline characteristics between non-Hispanic AA and non-Hispanic WH. AA were 25% less likely (95% confidence interval, 0.60-0.96) to be waitlisted than WH even after adjusting for medical factors and social determinants of health. In addition, being older, having lower income, public insurance, more comorbidities, and being on dialysis decreased the probability of waitlisting while having more social support and transplant knowledge increased the probability of waitlisting. Conclusions. Racial disparity in kidney transplant waitlisting persisted even after adjusting for medical factors and social determinants of health, suggesting the need to identify novel factors that impact racial disparity in transplant waitlisting. Developing interventions targeting cultural and psychosocial factors may enhance equity in access to transplantation.
引用
收藏
页码:1445 / 1455
页数:11
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