Abstract: SA-OR035
Residential Neighborhood Structural Racism and Access to Kidney Transplantation
Session Information
- Diversity and Equity in Kidney Health: Research and Cases
November 08, 2025 | Location: Room 361A, Convention Center
Abstract Time: 05:40 PM - 05:50 PM
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
- Bae, Sunjae, New York University Grossman School of Medicine, New York, New York, United States
- Orandi, Babak, 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
- Crews, Deidra C., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Purnell, Tanjala S., Johns Hopkins University, Baltimore, Maryland, United States
- Thorpe, Roland J., Johns Hopkins University, Baltimore, Maryland, United States
- Szanton, Sarah, Johns Hopkins University, 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
Structural racism is a key driver of racial and ethnic disparities in the diagnosis and management of chronic diseases; however, its impact on disparities in access to waitlisting and kidney transplantation (KT) is unclear.
Methods
We identified 501,444 adults (age≥18 years) with ESKD and 95,068 KT candidates (2015-2021) from USRDS. The residential neighborhood structural racism effect index was ascertained using the American Community Survey. Cause-specific hazards models quantified the adjusted hazard ratios (aHR) of waitlisting and KT (any KT, LDKT, and preemptive KT) across tertiles of the structural racism effect index. We used interaction terms to quantify the differential effect of the aforementioned associations by race and ethnicity.
Results
ESKD adults in high structural racism neighborhoods were less likely to be waitlisted (aHR=0.71,95%CI:0.69-0.72) than those in low structural racism neighborhoods. This effect was pronounced among Asian (aHR=0.87,95%CI:0.80-0.95), Black (aHR=0.68,95%CI:0.66-0.70), and Hispanic (aHR=0.89,95%CI:0.86-0.92) adults in high structural racism neighborhoods compared to White adults in low structural racism neighborhoods. Moreover, KT candidates in high structural racism neighborhoods were less likely to obtain any KT (aHR=0.89, 95%CI:0.87-0.92), LDKT (aHR=0.65, 95%CI:0.62-0.69), and preemptive KT (aHR=0.62, 95%CI:0.58-0.67), particuarly Black candidates compared to White candidates.
Conclusion
High structural racism neighborhoods likely contribute to persistent racial and ethnic disparities in access to waitlisting/KT. Community and stakeholder engagement in implementing initiatives that address structural racism and direct resources to affected neighborhoods can support equitable access to KT.
Funding
- NIDDK Support