Race and Electronically Measured Adherence to Immunosuppressive Medications after Deceased Donor Renal Transplantation

Weng, Francis L.; Israni, Ajay K.; Joffe, Marshall M.; Hoy, Tracey; Gaughan, Christina; Newman, Melissa; Abrams, John; Kamoun, Malek; Rosas, Sylvia E.; Mange, Kevin C.; Strom, Brian L.; Brayman, Kenneth L.; Feldman, Harold I.

doi:10.1681/asn.2004121059

Cited by 172 publications

(166 citation statements)

References 41 publications

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“…[2][3][4][5]18,25,26 Black Americans have lower access to renal transplantation than white Americans, probably because of lower referral rates for transplantation assessment, which may themselves be due to physician attitudes about poor adherence and lower graft success rates among black patients. 17,22,27,28 Numerous studies from the United States also show inferior graft outcomes among black transplant recipients. Data from the United Network for Organ Sharing registry showed that between 1995 and 1999, the 5-yr graft survival rates for deceased donor transplants was 70 and 55%, respectively, for white and black patients.…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, renal allograft survival is significantly lower in black than in white patients, [5][6][7][8][9][10] which might be due to higher immunologic risk, poorer medication adherence, or decreased access to pre-and posttransplantation care. 8,[11][12][13][14][15][16][17][18][19][20][21][22][23] Whether black Canadian transplant recipients also have decreased transplant survival is unclear because there are no published data describing transplant outcomes among this patient group. A recent study comparing outcomes in Canada and the United States demonstrated that American transplant recipients had an increased risk for mortality.…”

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confidence: 99%

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Similar Outcomes among Black and White Renal Allograft Recipients

Yeates¹,

Wiebe²,

Gill³

et al. 2009

Journal of the American Society of Nephrology

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Black renal transplant recipients experience shorter graft survival than white recipients, but no published data describe the graft outcomes among black Canadian recipients. Here, we analyzed data from the Canadian national renal replacement therapy registry, which included 20,243 incident dialysis patients (3% black, 97% white), 5036 of whom received a renal transplant during the study period. Black patients were significantly less likely to receive a renal transplant (deceased and living-donor combined) when compared with white patients (hazard ratio 0.59; 95% confidence interval 0.51 to 0.69; P Ͻ 0.0001). Among patients who underwent a renal transplant, there was no significant difference in the likelihood of graft failure between black and white patients, even after adjustment for comorbidities and socioeconomic status; black patients, however, had significantly lower posttransplantation mortality compared with white patients (hazard ratio 0.49; 95% confidence interval 0.28 to 0.88; P ϭ 0.02). In conclusion, graft outcomes between black and white Canadian renal transplant patients are similar. Because this differs from the experience reported from the United States, further direct comparisons between the two populations is warranted.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Similar Outcomes among Black and White Renal Allograft Recipients

Yeates¹,

Wiebe²,

Gill³

et al. 2009

Journal of the American Society of Nephrology

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“…30 The effects of transplant center on early and late allograft outcomes have been documented in the United States, Canada, England, and Ireland, [31][32][33][34][35] and adherence with immunosuppressants is associated with the transplant center. 36 Our study is the first to study the transplant center effect using common-donor recipients who underwent transplantation at the same and at different centers. Here, we showed that the within-pair odds for DGF were influenced by the transplant center.…”

Section: Discussionmentioning

confidence: 99%

“Nature versus Nurture” Study of Deceased-Donor Pairs in Kidney Transplantation

Louvar

Snyder³

et al. 2009

Journal of the American Society of Nephrology

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Donor characteristics such as age and cause of death influence the incidence of delayed graft function (DGF) and graft survival; however, the relative influence of donor characteristics ("nature") versus transplant center characteristics ("nurture") on deceased-donor kidney transplant outcomes is unknown. We examined the risks for DGF and allograft failure within 19,461 recipient pairs of the same donor's kidneys using data from the US Renal Data System. For the 11,894 common-donor pairs transplanted at different centers, a recipient was twice as likely to develop DGF when the recipient of the contralateral kidney developed DGF (odds ratio [OR] 2.05; 95% confidence interval [CI] 1.82 to 2.30). Similarly, for 7567 common-donor pairs transplanted at the same center, the OR for DGF was 3.02 (95% CI 2.62 to 3.48). For pairs transplanted at the same center, there was an additional 42% risk for DGF compared with pairs transplanted at different centers. After adjustment for DGF, the within-pair ORs for allograft failure by 1 yr were 1.92 (95% CI 1.33 to 2.77) and 1.77 (95% CI 1.25 to 2.52) for recipients who underwent transplantation at the same center and different centers, respectively. These data suggest that both unmeasured donor characteristics and transplant center characteristics contribute to the risk for DGF and that the former also contribute significantly to allograft failure.

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“…Differences in medication adherence by race-ethnicity exist and have been noted in several studies (2,(5)(6)(7)(8). This may be the result of external factors, such as income, possession of commercial health insurance (5), psychosocial stressors (e.g., residential crime rates) (2,9), and characteristics of the facility where care is provided (6).…”

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confidence: 99%

Race-Ethnic Differences in Factors Associated with Inhaled Steroid Adherence Among Adults with Asthma

2009

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Rationale: Adherence to inhaled corticosteroid (ICS) medication is known to be low overall, but tends to be lower among AfricanAmerican patients when compared with white patients. Objectives: To understand the factors that contribute to ICS adherence among African-American and white adults with asthma. Methods: Eligible individuals had a prior diagnosis of asthma, one or more ICS prescriptions, and were members of a large health maintenance organization in southeast Michigan. Individuals were sent a survey that included questions about internal factors (e.g., patient beliefs, knowledge, and motivation) and external factors (e.g., socioeconomic status, barriers to care, social support, and stressors) potentially related to ICS adherence. Adherence was calculated using electronic prescription and fill data. Stepwise regression was used to identify factors associated with adherence before and after stratifying by race-ethnicity. Measurements and Main Results: Surveys were returned by 1,006 (56.3%) of 1,787 eligible patients. Adjusting for internal factors, but not external factors, diminished the relationship between raceethnicity and ICS adherence. Among African-American patients, readiness to take ICS medication was the only internal or external factor significantly associated with ICS adherence; it explained 5.6% of the variance in adherence. Among white patients, perceived ICS necessity, ICS knowledge, doctors being perceived as the source of asthma control, and readiness to take medication were the internal factors associated with ICS adherence; these accounted for 19.8% of the variance in adherence. Conclusions: Factors associated with ICS adherence appear to differ between African-American and white patients, suggesting that group-specific approaches are needed to improve adherence.

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Race and Electronically Measured Adherence to Immunosuppressive Medications after Deceased Donor Renal Transplantation

Cited by 172 publications

References 41 publications

Similar Outcomes among Black and White Renal Allograft Recipients

Similar Outcomes among Black and White Renal Allograft Recipients

“Nature versus Nurture” Study of Deceased-Donor Pairs in Kidney Transplantation

Race-Ethnic Differences in Factors Associated with Inhaled Steroid Adherence Among Adults with Asthma

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