Journal article
Unexpected Race and Ethnicity Differences in the US National Veterans Affairs Kidney Transplant Program
Transplantation, Vol.103(12), pp.2701-2714
12/01/2019
DOI: 10.1097/TP.0000000000002905
PMCID: PMC6937592
PMID: 31397801
Abstract
Background. Racial/ethnic minorities have lower rates of deceased kidney transplantation (DDKT) and living donor kidney transplantation (LDKT) in the United States. We examined whether social determinants of health (eg, demographics, cultural, psychosocial, knowledge factors) could account for differences in the Veterans Affairs (VA) Kidney Transplantation (KT) Program. Methods. We conducted a multicenter longitudinal cohort study of 611 Veterans undergoing evaluation for KT at all National VA KT Centers (2010-2012) using an interview after KT evaluation and tracking participants via medical records through 2017. Results. Hispanics were more likely to get any KT (subdistribution hazard ratios [SHR] [95% confidence interval (CI)]: 1.8 [1.2-2.8]) or DDKT (SHR [95% CI]: 2.0 [1.3-3.2]) than non-Hispanic white in univariable analysis. Social determinants of health, including marital status (SHR [95% CI]: 0.6 [0.4-0.9]), religious objection to LDKT (SHR [95% CI]: 0.6 [0.4-1.0]), and donor preference (SHR [95% CI]: 2.5 [1.2-5.1]), accounted for some racial differences, and changes to Kidney Allocation System policy (SHR [95% CI]: 0.3 [0.2-0.5]) mitigated race differences in DDKT in multivariable analysis. For LDKT, non-Hispanic African American Veterans were less likely to receive an LDKT than non-Hispanic white (SHR [95% CI]: 0.2 [0.0-0.7]), but accounting for age (SHR [95% CI]: 1.0 [0.9-1.0]), insurance (SHR [95% CI]: 5.9 [1.1-33.7]), presenting with a living donor (SHR [95% CI]: 4.1 [1.4-12.3]), dialysis duration (SHR [95% CI]: 0.3 [0.2-0.6]), network of potential donors (SHR [95% CI]: 1.0 [1.0-1.1]), self-esteem (SHR [95% CI]: 0.4 [0.2-0.8]), transplant knowledge (SHR [95% CI]: 1.3 [1.0-1.7]), and changes to Kidney Allocation System policy (SHR [95% CI]: 10.3 [2.5-42.1]) in multivariable analysis eliminated those disparities. Conclusions. The VA KT Program does not exhibit the same pattern of disparities in KT receipt as non-VA centers. Transplant centers can use identified risk factors to target patients who may need more support to ensure they receive a transplant.
Details
- Title: Subtitle
- Unexpected Race and Ethnicity Differences in the US National Veterans Affairs Kidney Transplant Program
- Creators
- Larissa Myaskovsky - University of New MexicoKellee Kendall - University of PittsburghXingyuan Li - University of PittsburghChung-Chou H. Chang - University of PittsburghJohn R. Pleis - National Center for Health StatisticsEmilee Croswell - University of PittsburghC. Graham Ford - University of New MexicoGalen E. Switzer - University of PittsburghAnthony Langone - Vanderbilt UniversityAnuja Mittal-Henkle - Kaiser PermanenteSomnath Saha - Oregon Health & Science UniversityChristie P. Thomas - Roy J. and Lucille A. Carver College of MedicineJareen Adams Flohr - VA Pittsburgh Healthcare SystemMohan Ramkumar - VA Pittsburgh Healthcare SystemMary Amanda Dew - University of Pittsburgh
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.103(12), pp.2701-2714
- DOI
- 10.1097/TP.0000000000002905
- PMID
- 31397801
- PMCID
- PMC6937592
- NLM abbreviation
- Transplantation
- ISSN
- 0041-1337
- eISSN
- 1534-6080
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 14
- Grant note
- Veterans Health Administration; US Department of Veterans Affairs Health Services Research and Development Department of Veterans Affairs; US Department of Veterans Affairs R01DK081325 / National Institute of Diabetes Digestive and Kidney Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) Office of Research and Development IIR 06-220 / VA Health Services Research and Development Department; US Department of Veterans Affairs Dialysis Clinic, Inc
- Language
- English
- Date published
- 12/01/2019
- Academic Unit
- Stead Family Department of Pediatrics; Obstetrics and Gynecology; Nephrology; Internal Medicine
- Record Identifier
- 9984359942702771
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