Medical and Social Factors Do Not Explain Racial Disparities in Kidney Transplant

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Disparities in waitlisting for kidney transplantation among African American patients are independent of medical factors, and even of social determinants of health, reports a study in Transplantation.

The prospective cohort study included 1055 white or African American patients referred for kidney transplant evaluation in 2013 and followed up to 2018. At baseline, a wide range of potential predictors of transplant outcomes were assessed: demographic, medical/health, culturally related, and psychosocial factors, along with transplant-related knowledge, concerns, and preferences. All of these factors were evaluated for association with waitlisting for kidney transplantation.

At initial evaluation, African American patients were younger, of lower socioeconomic status, more likely to be on public insurance, and less likely to be married than white patients. African American patients also had more comorbid conditions, longer dialysis vintage, and more potential donors.

On initial analyses, African American patients were nearly one-half less likely to be waitlisted, compared to white patients: hazard ratio (HR) 0.56. The association was weaker but remained significant after adjustment for demographic and medical factors, HR 0.69; and after further adjustment for psychosocial factors, HR 0.75. Older age, lower income, public insurance, increased comorbidity, and being on dialysis at the time of evaluation were associated with a lower likelihood of waitlisting.

The study adds to previous evidence of racial disparities in kidney transplant waitlisting between African American and white patients. The disparities persist even after adjustment for cultural and psychosocial factors, such as perceived racism and experience of discrimination in healthcare. “Efforts to identify novel factors that continue to contribute to racial disparity are needed,” the researchers write [Ng Y-H, et al. Does racial disparity in kidney transplant waitlisting persist after accounting for social determinants of health? Transplantation 2020; 104:1445–1455, doi: 10.1097/TP.0000000000003002].