Social Determinants of Health and Race Disparities in Kidney Transplant

Author:

Wesselman HannahORCID,Ford Christopher GrahamORCID,Leyva Yuridia,Li XingyuanORCID,Chang Chung-Chou H.,Dew Mary Amanda,Kendall KelleeORCID,Croswell Emilee,Pleis John R.,Ng Yue HarnORCID,Unruh Mark L.,Shapiro Ron,Myaskovsky LarissaORCID

Abstract

Background and objectivesBlack patients have a higher incidence of kidney failure but lower rate of deceased- and living-donor kidney transplantation compared with White patients, even after taking differences in comorbidities into account. We assessed whether social determinants of health (e.g., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living-donor kidney transplantation.Design, setting, participants, & measurementsVia medical record review, we prospectively followed 1056 patients referred for kidney transplant (2010–2012), who completed an interview soon after kidney transplant evaluation, until their kidney transplant. We used multivariable competing risk models to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome.ResultsEven after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, less transplant knowledge, and fewer learning activities were each associated with a lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, and fewer learning activities were each associated with a lower probability of deceased-donor transplant. Black race, older age, lower income, public insurance, higher body mass index, dialysis before kidney transplant, not presenting with a potential living donor, religious objection to living-donor transplant, and less transplant knowledge were each associated with a lower probability of living-donor transplant.ConclusionsRace and social determinants of health are associated with the likelihood of undergoing kidney transplant.

Funder

National Institute of Diabetes and Digestive and Kidney Diseases

National Center for Advancing Translational Sciences

Dialysis Clinic Inc.

Publisher

American Society of Nephrology (ASN)

Subject

Transplantation,Nephrology,Critical Care and Intensive Care Medicine,Epidemiology

Reference68 articles.

1. United States Renal Data System : 2018 USRDS Annual Data Report: Epidemiology of kidney disease in the United States, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2018

2. Twenty years of evolving trends in racial disparities for adult kidney transplant recipients;Taber;Kidney Int,2016

3. Racial Disparities in the Optimal Delivery of Chronic Kidney Disease Care

4. Racial Differences in Determinants of Live Donor Kidney Transplantation in the United States

5. Influence of Race on Kidney Transplant Outcomes within and outside the Department of Veterans Affairs

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