Racial/Ethnic Differences in the Association Between Hospitalization and Kidney Transplantation Among Waitlisted End-Stage Renal Disease Patients

Newman, Kira L.; Fedewa, Stacey A.; Jacobson, Melanie H.; Adams, Andrew; Zhang, Rebecca; Pastan, Stephen O.; Patzer, Rachel E.

doi:10.1097/tp.0000000000001072

Cited by 8 publications

(8 citation statements)

References 33 publications

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“…Among waitlisted patients, racial and ethnic minorities were more likely to be hospitalized while waitlisted, decreasing the likelihood of being transplanted [ 188 ]. Once on the inactive list, White patients were more likely than Hispanic patients to resolve issues for inactivity, resulting in reactivation [ 189 ].…”

Section: Resultsmentioning

confidence: 99%

A scoping review of inequities in access to organ transplant in the United States

Park

Jones

Kaplan

et al. 2022

Int J Equity Health

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Background Organ transplant is the preferred treatment for end-stage organ disease, yet the majority of patients with end-stage organ disease are never placed on the transplant waiting list. Limited access to the transplant waiting list combined with the scarcity of the organ pool result in over 100,000 deaths annually in the United States. Patients face unique barriers to referral and acceptance for organ transplant based on social determinants of health, and patients from disenfranchised groups suffer from disproportionately lower rates of transplantation. Our objective was to review the literature describing disparities in access to organ transplantation based on social determinants of health to integrate the existing knowledge and guide future research. Methods We conducted a scoping review of the literature reporting disparities in access to heart, lung, liver, pancreas and kidney transplantation based on social determinants of health (race, income, education, geography, insurance status, health literacy and engagement). Included studies were categorized based on steps along the transplant care continuum: referral for transplant, transplant evaluation and selection, living donor identification/evaluation, and waitlist outcomes. Results Our search generated 16,643 studies, of which 227 were included in our final review. Of these, 34 focused on disparities in referral for transplantation among patients with chronic organ disease, 82 on transplant selection processes, 50 on living donors, and 61 on waitlist management. In total, 15 studies involved the thoracic organs (heart, lung), 209 involved the abdominal organs (kidney, liver, pancreas), and three involved multiple organs. Racial and ethnic minorities, women, and patients in lower socioeconomic status groups were less likely to be referred, evaluated, and added to the waiting list for organ transplant. The quality of the data describing these disparities across the transplant literature was variable and overwhelmingly focused on kidney transplant. Conclusions This review contextualizes the quality of the data, identifies seminal work by organ, and reports gaps in the literature where future research on disparities in organ transplantation should focus. Future work should investigate the association of social determinants of health with access to the organ transplant waiting list, with a focus on prospective analyses that assess interventions to improve health equity.

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Section: Resultsmentioning

confidence: 99%

A scoping review of inequities in access to organ transplant in the United States

Park

Jones

Kaplan

et al. 2022

Int J Equity Health

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“…One retrospective study of over 19,000 liver transplant recipients found that Asian Americans are significantly more likely to be hospitalized at time of wait-listing, 7 indicating a greater likelihood of delayed diagnosis, more advanced disease progression, and decreased chances for transplantation. 8 The need for liver transplants is especially critical for Asian Americans due to an extremely high incidence of hepatitis and resultant hepatic failure. 9 In 2016, nearly 20% of all newly reported cases of chronic hepatitis B in the US occurred in Asian Americans, and the death rate among Asian Americans from hepatitis B was more than triple that of non-Hispanic Black Americans.…”

Section: Asian American Need For Transplantationmentioning

confidence: 99%

Family First: Asian Americans’ Attitudes and Behaviors Toward Deceased Organ Donation

Siminoff

Bolt

Gardiner

et al. 2019

J. Racial and Ethnic Health Disparities

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Asian Americans have substantial transplantation needs but the lowest rates of organ donation in the United States. As the shortage of transplantable organs persists, the rate of deceased donation by Asian Americans has not kept pace with that of the general population. This report is a qualitative study of organ donation-related attitudes and beliefs of three Asian ethnic groups located in the greater Philadelphia metropolitan area: Chinese, Filipino, and Vietnamese Americans. Guided by a Community Advisory Board representing these groups, we conducted 9 focus groups with a total of 64 participants and subsequent thematic analyses. Six major themes emerged: (1) positive views about organ donation, (2) previous exposure to organ donation, (3) primacy of the family in decision making, (4) mistrust of the healthcare and donation systems, (5) religious and cultural beliefs concerning the body, and (6) isolation from mainstream American society. Although participants expressed commonalities and beliefs in line with other American racial and ethnic groups, we also identified unique beliefs, such as familial influence, religious and cultural concerns regarding body wholeness and the dead, and underlying reasons for medical mistrust, such as a belief in a black market. The study's findings challenge the dominant educational and awareness campaigns about organ donation decision making that focus on individual autonomy and overlook the need for incorporating the specific content and message delivery needs of Asian Americans. This study is the first to explore attitudes and knowledge about posthumous organ donation among US Asian American populations in at least a decade.

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“…Hospitalization for waitlisted individuals has documented associations with negative outcomes, including higher mortality while waitlisted 3 , lower likelihood of receiving a transplant 2 and higher likelihood of posttransplant complications 20 . In addition, hospitalizations may increase total medical costs 21 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, hospitalization is associated with a lower likelihood of receiving a transplant among waitlisted patients 2,3 . Furthermore, hospitalization may add to increased Medicare costs, making it important to identify potentially modifiable factors.…”

Section: Introductionmentioning

confidence: 99%

Hospitalization Among Individuals Waitlisted For Kidney Transplant

et al. 2017

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Background For patients waitlisted for a deceased-donor kidney, hospitalization is associated with a lower likelihood of transplantation and worse posttransplant outcomes. However, individual-, neighborhood-, and regional-level risk factors for hospitalization throughout the waitlist period and specific causes of hospitalization in this population are unknown. Methods We used United States Renal Data System Medicare-linked data on patients waitlisted between 2005 and 2013 with continuous enrollment in Medicare Parts A & B (n=53 810) to examine the association between annual hospitalization rate and a variety of demographic, clinical, and social factors. We used multi-level multivariable ordinal logistic regression to estimate odds ratios (OR). Results Factors associated with significantly increased hospitalization rates among waitlisted individuals included older age, female sex, more years on dialysis prior to waitlisting, tobacco use, PRA>0, public insurance or no insurance at ESRD diagnosis, more regional acute care hospital beds, and urban residence (all p<0.05). Among patients’ dialysis-dependent when waitlisted, individuals with arteriovenous fistulas were significantly less likely than individuals with indwelling catheters or grafts to be hospitalized (OR=0.79 and 0.82, respectively, both p<0.001). The most common causes of hospitalization were complications related to devices, implants, and grafts; hypertension; and sepsis. Conclusion Individual- and regional-level variables were significantly associated with hospitalization while waitlisted, suggesting that personal, health-system, and geographic factors may impact patients’ risk. Conditions related to dialysis access and comorbidities were common hospitalization causes, underscoring the importance proper access management and care for additional chronic health conditions.

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Racial/Ethnic Differences in the Association Between Hospitalization and Kidney Transplantation Among Waitlisted End-Stage Renal Disease Patients

Cited by 8 publications

References 33 publications

A scoping review of inequities in access to organ transplant in the United States

A scoping review of inequities in access to organ transplant in the United States

Family First: Asian Americans’ Attitudes and Behaviors Toward Deceased Organ Donation

Hospitalization Among Individuals Waitlisted For Kidney Transplant

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