Racial disparities persist in access to renal transplantation in the United States, but the degree to which patient and neighborhood socioeconomic status (SES) impacts racial disparities in deceased donor renal transplantation access has not been examined in the pediatric and adolescent end-stage renal disease (ESRD) population. We examined the interplay of race and SES in a population-based cohort of all incident pediatric ESRD patients <21 years from the United States Renal Data System from 2000 to 2008, followed through September 2009. Of 8 452 patients included, 30.8%were black, 27.6% white-Hispanic, 44.3% female and 28.0% lived in poor neighborhoods. A total of 63.4% of the study population was placed on the waiting list and 32.5% received a deceased donor transplant. Racial disparities persisted in transplant even after adjustment for SES, where minorities were less likely to receive a transplant compared to whites, and this disparity was more pronounced among patients 18–20 years. Disparities in access to the waiting list were mitigated in Hispanic patients with private health insurance. Our study suggests that racial disparities in transplant access worsen as pediatric patients transition into young adulthood, and that SES does not explain all of the racial differences in access to kidney transplantation.

Background Because ambient air pollution exposure occurs as mixtures, consideration of joint effects of multiple pollutants may advance our understanding of air pollution health effects. Methods We assessed the joint effect of air pollutants in selected combinations (representative of oxidant gases, secondary, traffic, power plant, and criteria pollutants; constructed using combinations of criteria pollutants and fine particulate matter (PM2.5) components) on pediatric asthma emergency department (ED) visits in Atlanta during 1998–2004. Joint effects were assessed using multi-pollutant Poisson generalized linear models controlling for time trends, meteorology and daily non-asthma upper respiratory ED visit counts. Rate ratios (RR) were calculated for the combined effect of an interquartile-range increment in each pollutant’s concentration. Results Increases in all of the selected pollutant combinations were associated with increases in warm-season pediatric asthma ED visits [e.g., joint effect rate ratio=1.13 (95% confidence interval 1.06–1.21) for criteria pollutants (including ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, and PM2.5)]. Cold-season joint effects from models without non-linear effects were generally weaker than warm-season effects. Joint effect estimates from multi-pollutant models were often smaller than estimates calculated based on single-pollutant model results, due to control for confounding. Compared with models without interactions, joint effect estimates from models including first-order pollutant interactions were largely similar. There was evidence of non-linear cold-season effects. Conclusions Our analyses illustrate how consideration of joint effects can add to our understanding of health effects of multi-pollutant exposures, and also illustrate some of the complexities involved in calculating and interpreting joint effects of multiple pollutants.

SummaryBackground and objectives In 2007, the Emory Transplant Center (ETC) kidney transplant program implemented a required educational session for ESRD patients referred for renal transplant evaluation to increase patient awareness and decrease loss to follow-up. The purpose of this study was to evaluate the association of the ETC education program on completion of the transplant evaluation process.Design, setting, participants, & measurements Incident, adult ESRD patients referred from 2005 to 2008 were included. Patient data were abstracted from medical records and linked with data from the United States Renal Data System. Evaluation completion was compared by pre-and posteducational intervention groups in binomial regression models accounting for temporal confounding.Results A total of 1126 adult ESRD patients were examined in two transplant evaluation eras (75% pre-and 25% postintervention). One-year evaluation completion was higher in the post-versus preintervention group (80.4% versus 44.7%, P,0.0001). In adjusted analyses controlling for time trends, the adjusted probability of evaluation completion at 1 year was higher among the intervention versus nonintervention group (risk ratio=1.38, 95% confidence interval=1.12-1.71). The effect of the intervention was stronger among black patients and those patients living in poor neighborhoods (likelihood ratio test for interaction, P,0.05).Conclusions Standardizing transplant education may help reduce some of the racial and socioeconomic disparities observed in kidney transplantation.

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BackgroundLymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression.Methodology/Principal FindingsA lymphedema management program was implemented in Odisha State, India from 2007–2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value  = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions.Conclusions/SignificanceThese results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes.