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

Abstract

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.

Social Determinants of Health and Race Disparities in Kidney Transplant

“…Recently, we found significant racial disparities in waitlisting for transplant (13). Black individuals were 25% less likely to be waitlisted, even after adjusting for medical factors and social determinants of health (13).…”

“…Recently, we found significant racial disparities in waitlisting for transplant (13). Black individuals were 25% less likely to be waitlisted, even after adjusting for medical factors and social determinants of health (13). Although we identified the factors that affect waitlisting, our understanding of disparities associated with receiving a transplant and type of transplant (living or deceased) remains limited.…”

“…National data and previous research demonstrate that disparities occur at every stage of the transplant process (i.e., referral, evaluation, transplantation, and post-transplant outcomes) (1,15), but different factors contribute to disparities in waitlisting versus receiving a transplant (2,4,16). Thus, it is important to determine which variables are associated with disparities in receiving a transplant, and the type of transplant received, independent of waitlisting (13,16).…”

Barriers to kidney transplantation in ESKD

“…This financial strain is much harder to be borne by potential donors with lower socioeconomic status. However, studies have found that even after adjusting for medical factors and social determinants of health, blacks are 25% less likely to be waitlisted than whites 49 . Thus, there are novel factors that are contributing to these disparities that need to be identified.…”

“…However, studies have found that even after adjusting for medical factors and social determinants of health, blacks are 25% less likely to be waitlisted than whites. 49 Thus, there are novel factors that are contributing to these disparities that need to be identified. In a survey of dialysis patients, over 60% of black patients reported having faced racial discrimination at some point in their lives, with 10%-15% reporting having faced it while seeking medical care.…”