| Title | Racial differences in determinants of live donor kidney transplantation in the United States |
| Publication Type | Journal Article |
| Year of Publication | 2013 |
| Authors | Purnell, TS, Xu, P, Leca, N, Hall, YN |
| Journal | Am J TransplantAm J Transplant |
| Volume | 13 |
| Pagination | 1557-65 |
| Date Published | Jun |
| ISBN Number | 1600-6143 (Electronic)<br/>1600-6135 (Linking) |
| Accession Number | 23669021 |
| Keywords | Adolescent, 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 |
| Abstract | Few 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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