Affiliation:
1. Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
2. Department of Surgery New York University Grossman School of Medicine New York New York USA
3. Rory Meyers College of Nursing New York University New York New York USA
4. Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore Maryland USA
5. Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
6. Department of Population Health New York University Grossman School of Medicine New York New York USA
Abstract
ABSTRACTBackgroundMedical distrust may hinder kidney transplantation (KT) access. Among KT candidates evaluated for waitlisting, we identified factors associated with high distrust levels and quantified their association with waitlisting.MethodsAmong 812 candidates (2018–2023), we assessed distrust using the Revised Health Care System Distrust Scale across composite, competence, and values subscales. We used linear regression to quantify the associations between candidate and neighborhood‐level factors and distrust scores. We used Cox models to quantify the associations between distrust scores and waitlisting.ResultsAt KT evaluation, candidates who were aged 35–49 years (difference = 1.97, 95% CI: 0.78–3.16), female (difference = 1.10, 95% CI: 0.23–1.97), and Black (difference = 1.47, 95% CI: 0.47–2.47) were more likely to report higher composite distrust score. For subscales, candidates aged 35–49 were more likely to have higher competence distrust score (difference = 1.14, 95% CI: 0.59–1.68) and values distrust score (difference = 0.83, 95% CI: 0.05–1.61). Race/ethnicity (Black, difference = 1.42, 95% CI: 0.76–2.07; Hispanic, difference = 1.52, 95% CI: 0.35–2.69) was only associated with higher values distrust scores. Female candidates reporting higher rescaled values distrust scores (each one point) had a lower chance of waitlisting (aHR = 0.78, 95% CI: 0.63–0.98), whereas this association was not observed among males. Similarly, among non‐White candidates, each 1‐point increase in both rescaled composite (aHR = 0.87, 95% CI: 0.77–0.99) and values (aHR = 0.82, 95% CI: 0.68–0.99) distrust scores was associated with a lower chance of waitlisting, while there was no association among White candidates.ConclusionFemale, younger, and non‐White candidates reported higher distrust scores. Values distrust may contribute to the long‐standing racial/ethnic and gender disparities in access to KT. Implementing tailored strategies to reduce distrust in transplant care may improve KT access for groups that experience persistent disparities.
Funder
National Institute of Allergy and Infectious Diseases
National Institute on Aging
National Institute of Diabetes and Digestive and Kidney Diseases