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Abstract: FR-PO791

Health Equity Gaps in Access to Kidney Transplant

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health


  • Lan, Chiao Wen, Health Services Advisory Group Inc, Phoenix, Arizona, United States
  • Crews, Deidra C., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Mohan, Sumit, Columbia University, New York, New York, United States
  • Morgan-Johnson, Sherri, Centers for Medicare and Medicaid Services (CMS), Baltimore, Maryland, United States
  • Murphy, Melissa, Centers for Medicare and Medicaid Services (CMS), Baltimore, Maryland, United States

Research has documented cascading barriers to care, while accessing kidney transplant across neighborhood characteristics have not been fully examined.


ESRD Quality Reporting System (EQRS) data between 1/1/2015-5/20/2023 were analyzed. Access to transplants is examined, including calculating time on dialysis to listing and time on list before transplanted. Data were linked to the Area Deprivation Index (ADI), a neighborhood-level metric that combined 17 specific indicators (e.g., poverty, housing).


9.5% of patients added to the waitlist were from the most disadvantaged neighborhoods, while 14.6% of ESRD patients residing there. Among patients who received transplants, waitlist time was consistently longer for Black patients compared to White patients (p<0.001), and the difference has narrowed over the years, yet the gap remains. Neighborhood characteristics are associated with health disparities, where patients from more disadvantaged neighborhoods waited longer on the list before getting transplanted than those from the least disadvantaged areas (15.3 vs. 13.4 months, p<0.0001). Racial disparities exist across neighborhood socioeconomic level. White ESRD patients in the most disadvantaged neighborhoods were added to the waitlist faster than Black patients in the least disadvantaged neighborhoods (38.6 vs. 43.2 months, p<0.01). The time on the list before transplantation among White patients in the most disadvantaged neighborhood was shorter than Black patients in the least disadvantaged neighborhoods (14.9 vs. 16.1 months, p<0.0001).


The results show significant disparities in access to care among ESRD patients in disadvantaged neighborhoods and that Black patients have reduced access to the transplant waitlist regardless of neighborhood characteristics. These results emphasize the need for policies and strategies that overcome structural racism barriers in addition to improving access for socioeconomically disadvantaged patients.


  • Other U.S. Government Support