Social Determinants of Health and Race Disparities in Kidney Transplant

作者：Hannah M. Wesselman, Christopher Graham Ford, Yuridia L. Leyva, Xingyuan Li, Chung‐Chou H. Chang, Mary Amanda Dew, Kellee Kendall, Emilee J. Croswell, John R. Pleis, Yue‐Harn Ng, Mark L. Unruh, Ron Shapiro, Larissa Myaskovsky · 发表于：Clinical Journal of the American Society of Nephrology · 年份：2021 · DOI：10.2215/cjn.04860420 · 被引用次数：161 · 研究领域：Organ Donation and Transplantation、Renal Transplantation Outcomes and Treatments、Transplantation: Methods and Outcomes

BACKGROUND AND OBJECTIVES: ., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living-donor kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: medical record review, we prospectively followed 1056 patients referred for kidney transplant (2010-2012), who completed an interview soon after kidney transplant evaluation, until their kidney transplant. We used multivariable competing risk models to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome. RESULTS: Even after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, less transplant knowledge, and fewer learning activities were each associated with a lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religi...