Logo image
Back
Has the Department of Veterans Affairs Found a Way to Avoid Racial Disparities in the Evaluation Process for Kidney Transplantation?
Journal article   Open access   Peer reviewed

Has the Department of Veterans Affairs Found a Way to Avoid Racial Disparities in the Evaluation Process for Kidney Transplantation?

Michael A Freeman, John R Pleis, Kellee R Bornemann, Emilee Croswell, Mary Amanda Dew, Chung-Chou H Chang, Galen E Switzer, Anthony Langone, Anuja Mittal-Henkle, Somnath Saha, …
Transplantation, Vol.101(6), pp.1191-1199
06/2017
DOI: 10.1097/TP.0000000000001377
PMCID: PMC5288397
PMID: 27482965
url
https://doi.org/10.1097/TP.0000000000001377View
Published (Version of record) Open Access

Abstract

Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66-0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.
 United States Emotions Humans Middle Aged Healthcare Disparities - ethnology Male Ethnic Groups - psychology Kidney Failure, Chronic - ethnology Kidney Transplantation - methods Health Knowledge, Attitudes, Practice - ethnology Patient Selection Clinical Decision-Making Female Interviews as Topic Waiting Lists Patient Education as Topic Process Assessment, Health Care Veterans Health - ethnology Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - surgery Risk Factors Cultural Characteristics Kaplan-Meier Estimate Proportional Hazards Models Chi-Square Distribution Minority Groups - psychology United States Department of Veterans Affairs Aged Longitudinal Studies

Details

Metrics

18 Record Views
25 Times Cited - Web of Science
Logo image