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Racial differences in determinants of live donor kidney transplantation in the United States

TitleRacial differences in determinants of live donor kidney transplantation in the United States
Publication TypeJournal Article
Year of Publication2013
AuthorsPurnell, TS, Xu, P, Leca, N, Hall, YN
JournalAm J TransplantAm J Transplant
Volume13
Pagination1557-65
Date PublishedJun
ISBN Number1600-6143 (Electronic)<br/>1600-6135 (Linking)
Accession Number23669021
KeywordsAdolescent, Adult, Aged, Continental Population Groups, Female, Humans, Kidney Failure, Chronic/ethnology/ surgery, Kidney Transplantation/ ethnology, Living Donors, Male, Middle Aged, Minority Groups, Poverty, Registries, Retrospective Studies, United States/epidemiology, Young Adult
AbstractFew studies have compared determinants of live donor kidney transplantation (LDKT) across all major US racial-ethnic groups. We compared determinants of racial-ethnic differences in LDKT among 208 736 patients who initiated treatment for end-stage kidney disease during 2005-2008. We performed proportional hazards and bootstrap analyses to estimate differences in LDKT attributable to sociodemographic and clinical factors. Mean LDKT rates were lowest among blacks (1.19 per 100 person-years [95% CI: 1.12-1.26]), American Indians/Alaska Natives-AI/ANs (1.40 [1.06-1.84]) and Pacific Islanders (1.10 [0.78-1.84]), intermediate among Hispanics (2.53 [2.39-2.67]) and Asians (3.89 [3.51-4.32]), and highest among whites (6.46 [6.31-6.61]). Compared with whites, the largest proportion of the disparity among blacks (20%) and AI/ANs (29%) was attributed to measures of predialysis care, while the largest proportion among Hispanics (14%) was attributed to health insurance coverage. Contextual poverty accounted for 16%, 4%, 18%, and 6% of the disparity among blacks, Hispanics, AI/ANs and Pacific Islanders but none of the disparity among Asians. In the United States, significant disparities in rates of LDKT persist, but determinants of these disparities vary by race-ethnicity. Efforts to expand preESKD insurance coverage, to improve access to high-quality predialysis care and to overcome socioeconomic barriers are important targets for addressing disparities in LDKT.
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