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Abstract: SA-OR002

Identification of Factors That Explain Racial Disparities during the Evaluation Process for Kidney Transplantation

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Murphy, Karly A., Johns Hopkins University, Baltimore, Maryland, United States
  • Ying, Hao, Johns Hopkins University, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States
Background

Racial disparities between blacks and white patients are observed in evaluation completion rates, a step required for kidney transplantation (KT) listing. However, the role of patient-level demographics and medical comorbidities as explanatory factors for these disparities is unclear. We compared the risk of listing in black versus white adults referred to clinic for KT evaluation and identified whether the association of socio-economic factors and medical co-morbidities account for racial disparities in listing for KT.

Methods

As part of a prospective multi-center cohort study of aging and ESRD, 3,540 black and white candidates were enrolled at evaluation for KT (1/2009-12/2017). Self-reported demographic data, education, income, employment, and frailty status was collected at time of first evaluation. Medical comorbidities were ascertained from self-report and chart review. Time to listing in the first year was our primary outcome. We used multivariate Cox proportional hazard models to estimate incidence for listing and the association of patient-level factors between black and white participants. Mediation analysis was performed using percent reduction in beta coefficient for race in expanded model versus a base model, adjusted for age and sex.

Results

Among 3,540 participants, the mean age was 54.7 years (sd=13.5) with 41.2% female and 49.2% self-reported black race. Overall, 1,930 patients were listed for KT in the first year. Likelihood of listing was lower for blacks compared with whites (HR=0.77, 95% CI:0.70-0.84) after adjusting for age and gender. Racial differences in listing rates were partially explained by socio-economic factors (% reduction in beta coefficient, 38.5%) and partially explained by medical co-morbidity (% reduction in beta coefficient, 35.6%). After accounting for age, gender, patient-level socioeconomic factors, and medical comorbidity, disparity by race persisted (adjusted HR 0.89, 95% CI 0.81-0.98, % reduction in beta 47.6%).

Conclusion

Racial disparities during the listing stage of KT are partly explained by differences in patient-level socio-economic factors and medical comorbidity. Higher socio-economic status may indicate greater personal resources to navigate the transplant process and could direct future intervention.

Funding

  • Other NIH Support