Abstract: SA-OR036
Association of ESRD Quality Incentive Program Dialysis Facility Quality with Racial Disparities in Transplant Wait-Listing
Session Information
- Diversity and Equity in Kidney Health: Research and Cases
November 08, 2025 | Location: Room 361A, Convention Center
Abstract Time: 05:50 PM - 06:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Alausa, Jameel, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
- Zhu, Mengqi, The University of Chicago Medicine, Chicago, Illinois, United States
- White, Molly, The University of Chicago Medicine, Chicago, Illinois, United States
- Parker, William F, The University of Chicago Medicine, Chicago, Illinois, United States
- Saunders, Milda R., The University of Chicago Medicine, Chicago, Illinois, United States
Background
We examined whether dialysis facility quality is associated with racial disparities in kidney transplant waitlisting.
Methods
We linked the US Renal Data System (USRDS) with 2019 Dialysis Facility Compare (DFC) and 2020 Quality Incentive Program (QIP) Payment Year files to create a cohort of 68,844 Non-Hispanic Black and White patients who began hemodialysis in 2018, with follow-up through March 2020. The primary outcome was time to kidney transplant waitlisting, and facility quality was assessed through QIP Total Performance Score (TPS). Mixed effects Cox proportional hazards models estimated associations between race, facility quality, and waitlisting while adjusting for key sociodemographic, clinical risk factors and within-center association.
Results
Among the cohort, Black patients (35.6%) were more likely to be younger, female, and dual-eligible (all p<0.001). Black patients were less likely to receive care at high-quality facilities (OR 0.58, p<0.001) and to be waitlisted compared to White patients (aHR: 0.88, 95% CI: 0.83, 0.93, p<0.001). Patients treated at low-quality facilities had a lower likelihood of waitlisting than those at high-quality ones (aHR: 0.83; CI: 0.78, 0.88; p<0.001). Compared to White patients at high-quality facilities, both Black patients at high-quality facilities and White patients at low-quality facilities had lower waitlisting likelihoods (aHR: 0.90; 95% CI: 0.83, 0.98; p<0.01; aHR: 0.84; 95% CI: 0.78, 0.91; p<0.001). Black patients at low-quality facilities were most disadvantaged (aHR: 0.73, 95% CI: 0.67, 0.79; p<0.001).
Conclusion
Facility quality is associated with waitlisting outcomes, but improving facility quality may be insufficient to eliminate waitlisting disparities for Black patients. Targeted policy interventions, including social risk payment adjustments and equity-focused quality domains, are necessary to promote fair access to transplant and to prevent divestment from safety-net dialysis facilities.
Funding
- NIDDK Support