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Kidney Week

Abstract: FR-PO800

Structural Racism and Access to Kidney Transplantation: Examining Residential and Transplant Center Segregation

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Li, Yiting, New York University Grossman School of Medicine, New York, New York, United States
  • Menon, Gayathri, New York University Grossman School of Medicine, New York, New York, United States
  • Kim, Byoungjun, New York University Grossman School of Medicine, New York, New York, United States
  • Quint, Evelien, Universitair Medisch Centrum Groningen Centrum voor Congenitale Hartafwijkingen, Groningen, Groningen, Netherlands
  • Clark-Cutaia, Maya N., New York University Grossman School of Medicine, New York, New York, United States
  • Wu, Wenbo, New York University Grossman School of Medicine, New York, New York, United States
  • Szanton, Sarah, Johns Hopkins University, Baltimore, Maryland, United States
  • Crews, Deidra C., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Purnell, Tanjala S., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Segev, Dorry L., New York University Grossman School of Medicine, New York, New York, United States
  • McAdams-DeMarco, Mara, New York University Grossman School of Medicine, New York, New York, United States
Background

Disparities in kidney transplantation (KT) access exist for systematically disadvantaged communities. Racial/ethnic segregation, a marker of structural racism, in a candidate’s residential neighborhood and their transplant center’s neighborhood may drive KT disparities.

Methods

We identified 158,506 Black and White KT candidates (age≥18) first listed between 1995-2021 using SRTR. Segregation scores were calculated based on Thiel's H method. These scores were subsequently categorized into tertiles. We used proportional hazards models, adjusting for individual- and neighborhood-level factors, to quantify the likelihood of deceased donor KT (DDKT) and live-donor KT (LDKT). We also assessed the differential impact of segregation on KT access for Black candidates, using an interaction term of segregation tertiles and candidate race.

Results

Black candidates were more likely to reside in high-segregation neighborhoods (70.1% vs. 30.9%; P <0.001) and be listed at transplant centers located in these neighborhoods (63.9% vs. 38.2%; P<0.001). Candidates living in a high-segregation neighborhood were less likely to receive LDKT but not DDKT; furthermore, residence in a high-segregated neighborhood was associated with lower access to LDKT for Black candidates (aHR=0.88, 95%CI: 0.82-0.95) but not White candidates (Pinteraction<0.001). Candidates listed in centers in a high-segregation neighborhood had lower access to DDKT, independent of race. However, LDKT access was lower for Black candidates listed at centers in a high-segregation neighborhood (aHR=0.90, 95%CI: 0.84-0.97; Pinteraction=0.042).

Conclusion

Access to LDKT was significantly lower for Black candidates who resided in or were listed in centers in segregated neighborhoods, and access to DDKT was lower for all candidates whose centers were in high-segregation neighborhoods. Targeted efforts should address the impacts of racial/ethnic segregation on equitable access to KT.

Funding

  • NIDDK Support