Gender Disparities in Kidney Transplantation Referral Vary by Age and Race: A Multiregional Cohort Study in the Southeast United States

Gender Disparities in Access to Kidney Transplant: Inequities in the Inequity

“…Similarly, contrary to earlier literature, Smothers et al. 1 also demonstrate increased referral rates in overweight and class I/II obese versus normal-weight individuals. Although earlier studies have shown that obese (body mass index >35–39 kg/m 2 ) women, but not men, have a lower likelihood of activation on the transplant waitlist and subsequent transplantation, S2 the study by Smothers et al.…”

“…Although earlier studies have shown that obese (body mass index >35–39 kg/m 2 ) women, but not men, have a lower likelihood of activation on the transplant waitlist and subsequent transplantation, S2 the study by Smothers et al. 1 suggests that obesity does not modify the association between gender and referral for transplant (acknowledging the interaction term was borderline significant [ P = 0.063]). The current study does not evaluate subsequent steps in the continuum from referral to transplant however, and although obesity may not limit referral for women, whether subsequent activation and transplantation rates for obese individuals differ by gender in this unique population remains to be seen.…”

“…In this issue of KI Reports , Smothers et al. 1 evaluate the modifying effects of patient age, race/ethnicity, and obesity status on gender disparities in transplant referral in a large population in the Southeastern United States. In keeping with earlier literature, women were 14% less likely to be referred for kidney transplant; this was particularly prominent among older and non-Hispanic White women.…”

“…Smothers et al. 1 evaluate kidney transplant referral rates by gender in the first year after dialysis initiation. Earlier studies have shown that the disparate referral rates by race (in the setting of lower referral rates among Black compared with White patients) are abolished if a longer time horizon is used (e.g., referral within 4–5 years).…”

State-of-the-art Meeting on Sex and Gender in Transplantation: The Female Perspective

“…This phenomenon is strongly related to societal/cultural norms that place women in caregiving or helping roles, both in their families and in the larger society. Women with certain medical conditions (eg, type 2 diabetes 1 and obesity 2 ), ethnicities (non-Hispanic White and Black women 3 ), or advanced age are disadvantaged in access to transplantation. 4 Although women are less likely to be waitlisted than men, older women show better transplantation outcomes than older men.…”