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Differences in access to kidney transplantation between Hispanic and non-Hispanic whites by geographic location in the United States.
Clin J Am Soc Nephrol. 2013 Dec; 8(12):2149-57.CJ

Abstract

BACKGROUND AND OBJECTIVES

Hispanic patients undergoing chronic dialysis are less likely to receive a kidney transplant compared with non-Hispanic whites. This study sought to elucidate disparities in the path to receipt of a deceased donor transplant between Hispanic and non-Hispanic whites.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Using the US Renal Data System, 417,801 Caucasians who initiated dialysis between January 1, 1995 and December 31, 2007 with follow-up through 2008 were identified. This study investigated time from first dialysis to first kidney transplantation, time from first dialysis to waitlisting, and time from waitlisting to kidney transplantation. Multivariable Cox regression estimated cause-specific hazard ratios (HRCS) and subdistribution (competing risk) hazard ratios (HRSD) for Hispanics versus non-Hispanic whites.

RESULTS

Hispanics experienced lower adjusted rates of deceased donor kidney transplantation than non-Hispanic whites (HRCS, 0.77; 95% confidence interval [95% CI], 0.75 to 0.80) measured from dialysis initiation. No meaningful differences were found in time from dialysis initiation to placement on the transplant waitlist. Once waitlisted, Hispanics had lower adjusted rates of deceased donor kidney transplantation (HRCS, 0.66; 95% CI, 0.64 to 0.68), and the association attenuated once accounting for competing risks (HRSD, 0.79; 95% CI, 0.77 to 0.81). Additionally controlling for blood type and organ procurement organization further reduced the disparity (HRSD, 0.99; 95% CI, 0.96 to 1.02).

CONCLUSIONS

After accounting for geographic location and controlling for competing risks (e.g., Hispanic survival advantage), the disparity in access to deceased donor transplantation was markedly attenuated among Hispanics compared with non-Hispanic whites. To overcome the geographic disparities that Hispanics encounter in the path to transplantation, organ allocation policy revisions are needed to improve donor organ equity.

Authors+Show Affiliations

Divisions of Nephrology and, †General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24115195

Citation

Arce, Cristina M., et al. "Differences in Access to Kidney Transplantation Between Hispanic and non-Hispanic Whites By Geographic Location in the United States." Clinical Journal of the American Society of Nephrology : CJASN, vol. 8, no. 12, 2013, pp. 2149-57.
Arce CM, Goldstein BA, Mitani AA, et al. Differences in access to kidney transplantation between Hispanic and non-Hispanic whites by geographic location in the United States. Clin J Am Soc Nephrol. 2013;8(12):2149-57.
Arce, C. M., Goldstein, B. A., Mitani, A. A., Lenihan, C. R., & Winkelmayer, W. C. (2013). Differences in access to kidney transplantation between Hispanic and non-Hispanic whites by geographic location in the United States. Clinical Journal of the American Society of Nephrology : CJASN, 8(12), 2149-57. https://doi.org/10.2215/CJN.01560213
Arce CM, et al. Differences in Access to Kidney Transplantation Between Hispanic and non-Hispanic Whites By Geographic Location in the United States. Clin J Am Soc Nephrol. 2013;8(12):2149-57. PubMed PMID: 24115195.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differences in access to kidney transplantation between Hispanic and non-Hispanic whites by geographic location in the United States. AU - Arce,Cristina M, AU - Goldstein,Benjamin A, AU - Mitani,Aya A, AU - Lenihan,Colin R, AU - Winkelmayer,Wolfgang C, Y1 - 2013/10/10/ PY - 2013/10/12/entrez PY - 2013/10/12/pubmed PY - 2014/8/29/medline SP - 2149 EP - 57 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 8 IS - 12 N2 - BACKGROUND AND OBJECTIVES: Hispanic patients undergoing chronic dialysis are less likely to receive a kidney transplant compared with non-Hispanic whites. This study sought to elucidate disparities in the path to receipt of a deceased donor transplant between Hispanic and non-Hispanic whites. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, 417,801 Caucasians who initiated dialysis between January 1, 1995 and December 31, 2007 with follow-up through 2008 were identified. This study investigated time from first dialysis to first kidney transplantation, time from first dialysis to waitlisting, and time from waitlisting to kidney transplantation. Multivariable Cox regression estimated cause-specific hazard ratios (HRCS) and subdistribution (competing risk) hazard ratios (HRSD) for Hispanics versus non-Hispanic whites. RESULTS: Hispanics experienced lower adjusted rates of deceased donor kidney transplantation than non-Hispanic whites (HRCS, 0.77; 95% confidence interval [95% CI], 0.75 to 0.80) measured from dialysis initiation. No meaningful differences were found in time from dialysis initiation to placement on the transplant waitlist. Once waitlisted, Hispanics had lower adjusted rates of deceased donor kidney transplantation (HRCS, 0.66; 95% CI, 0.64 to 0.68), and the association attenuated once accounting for competing risks (HRSD, 0.79; 95% CI, 0.77 to 0.81). Additionally controlling for blood type and organ procurement organization further reduced the disparity (HRSD, 0.99; 95% CI, 0.96 to 1.02). CONCLUSIONS: After accounting for geographic location and controlling for competing risks (e.g., Hispanic survival advantage), the disparity in access to deceased donor transplantation was markedly attenuated among Hispanics compared with non-Hispanic whites. To overcome the geographic disparities that Hispanics encounter in the path to transplantation, organ allocation policy revisions are needed to improve donor organ equity. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/24115195/Differences_in_access_to_kidney_transplantation_between_Hispanic_and_non_Hispanic_whites_by_geographic_location_in_the_United_States_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=24115195 DB - PRIME DP - Unbound Medicine ER -