Health Insurance Trends in United States Living Kidney Donors (2004 to 2015)

Rodrigue, James R.; Fleishman, Aaron

doi:10.1111/ajt.13827

Cited by 14 publications

(4 citation statements)

References 40 publications

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“…The potential for an interruption in employment or loss of employment may pose a greater concern for loss of work-related benefits, including health insurance, in men. Ensuring adequate medical follow-up for living donors postdonation is increasingly recognized a priority for transplantation programs, 22,23 and therefore lack of health insurance may be a significant barrier to donation. Because a larger proportion of women in the United States have their health insurance benefits covered as a dependent, 24 the threat of job loss may not necessarily affect their ability to access health care in the future.…”

Section: Discussionmentioning

confidence: 99%

The Change in Living Kidney Donation in Women and Men in the United States (2005–2015): A Population-Based Analysis

Gill

Joffres

Rose

et al. 2018

JASN

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The factors underlying the decline in living kidney donation in the United States since 2005 must be understood to inform strategies to ensure access to this option for future patients. Population-based estimates provide a better assessment of donation activity than do trends in the number of living donor transplants. Using data from the Scientific Registry of Transplant Recipients and the United States Census, we determined longitudinal changes in living kidney donation between 2005 and 2015, focusing on the effect of sex and income. We used multilevel Poisson models to adjust for differences in age, race, the incidence of ESRD, and geographic factors (including population density, urbanization, and daily commuting). During the study period, the unadjusted rate of donation was 30.1 and 19.3 per million population in women and men, respectively, and the adjusted incidence of donation was 44% higher in women (incidence rate ratio [IRR], 1.44; 95% confidence interval [95% CI], 1.39 to 1.49). The incidence of donation was stable in women (IRR, 0.95; 95% CI, 0.84 to 1.07) but declined in men (IRR, 0.75; 95% CI, 0.68 to 0.83). Income was associated with longitudinal changes in donation in both sexes, yet donation was stable in the highest two population income quartiles in women but only in the highest income quartile in men. In both sexes, living related donations declined, irrespective of income. In conclusion, living donation declined in men but remained stable in women between 2005 and 2015, and income appeared to have a greater effect on living donation in men.

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Section: Discussionmentioning

confidence: 99%

The Change in Living Kidney Donation in Women and Men in the United States (2005–2015): A Population-Based Analysis

Gill

Joffres

Rose

et al. 2018

JASN

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“…Historically, lack of access to health insurance may have presented a barrier to PCP utilization for some donors. A study of donor health insurance by Rodrigue and colleagues reported that 16% of donors were uninsured at the time of donation; young donors, male donors, and nonwhite donors were at increased risk of lacking health insurance . Our group has previously reported difficulties among live kidney donors in obtaining or changing health insurance after donation .…”

Section: Discussionmentioning

confidence: 73%

Patterns of primary care utilization before and after living kidney donation

Alejo

Luo

Massie

et al. 2017

Clinical Transplantation

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Background Annual visits with a primary care provider (PCP) are recommended for living kidney donors to monitor long-term health post-donation, yet adherence to this recommendation is unknown. Methods We surveyed 1170 living donors from our center from 1970–2012 to ascertain frequency of PCP visits pre- and post-donation. Interviews occurred median (IQR) 6.6 (3.8 – 11.0) years post-transplant. We used multivariate logistic regression to examine associations between donor characteristics and PCP visit frequency. Results Overall, only 18.6% had less-than-annual PCP follow-up post-donation. The strongest predictor of post-donation PCP visit frequency was pre-donation PCP visit frequency. Donors who had less-than-annual PCP visits before donation were substantially more likely to report less-than-annual PCP visits post-donation (OR = 9.814.421.0, p<0.001). Men were more likely to report less-than-annual PCP visits post-donation (adjusted OR = 1.21.62.3, p<0.01); this association was amplified in unmarried/non-cohabiting men (aOR = 2.43.96.3, p<0.001). Donors without college education were also more likely to report less-than-annual PCP visits post-donation (aOR = 1.31.82.5, p=0.001). Conclusions The importance of annual PCP visits should be emphasized to all living donors, especially those with less education, men (particularly single men) and donors who did not see their PCP annually before donation.

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“…528,530,531 Lack of health insurance had been more common among living kidney donors in the United States than in the general US population, although that disparity has not been present in recent years, perhaps due to changes in the economy and policy changes including the Patient Protection and Affordable Care Act (ACA). 533,534 Lack of insurance and lower educational attainment may pose lesser obstacles to follow-up in other countries where national healthcare is available. Among US centers in 2008 to 2012, large annual living donation volumes were also associated with increased rates of follow-up deficiencies.…”

Section: Follow-up Timing and Processesmentioning

confidence: 99%

Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage

Mata

Clayton

Kelly

et al. 2020

Transplantation Direct

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The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.

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Health Insurance Trends in United States Living Kidney Donors (2004 to 2015)

Cited by 14 publications

References 40 publications

The Change in Living Kidney Donation in Women and Men in the United States (2005–2015): A Population-Based Analysis

The Change in Living Kidney Donation in Women and Men in the United States (2005–2015): A Population-Based Analysis

Patterns of primary care utilization before and after living kidney donation

Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage

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