Social determinants of health and race disparities in kidney transplant

Hannah Wesselman, Christopher Graham Ford, Yuridia Leyva, Xingyuan Li, Chung Chou H. Chang, Mary Amanda Dew, Kellee Kendall, Emilee Croswell, John R. Pleis, Yue Harn Ng, Mark L. Unruh, Ron Shapiro, Larissa Myaskovsky

Research output: Contribution to journalArticlepeer-review

107 Scopus citations

Abstract

Background and objectives Black 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 trans-plantation. Design, setting, participants, & measurements Via 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. Results Even 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. Conclusions Race and social determinants of health are associated with the likelihood of undergoing kidney transplant.

Original languageEnglish
Pages (from-to)262-274
Number of pages13
JournalClinical Journal of the American Society of Nephrology
Volume16
Issue number2
DOIs
StatePublished - 2021
Externally publishedYes

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