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Comparative Study
. 2013 Jun;13(6):1557-65.
doi: 10.1111/ajt.12258. Epub 2013 May 13.

Racial differences in determinants of live donor kidney transplantation in the United States

T S Purnell  1 , P Xu, N Leca, Y N Hall
Affiliations
Comparative Study

Racial differences in determinants of live donor kidney transplantation in the United States

T S Purnell et al. Am J Transplant. 2013 Jun.

Abstract

Few studies have compared determinants of live donor kidney transplantation (LDKT) across all major US racial-ethnic groups. We compared determinants of racial-ethnic differences in LDKT among 208 736 patients who initiated treatment for end-stage kidney disease during 2005-2008. We performed proportional hazards and bootstrap analyses to estimate differences in LDKT attributable to sociodemographic and clinical factors. Mean LDKT rates were lowest among blacks (1.19 per 100 person-years [95% CI: 1.12-1.26]), American Indians/Alaska Natives-AI/ANs (1.40 [1.06-1.84]) and Pacific Islanders (1.10 [0.78-1.84]), intermediate among Hispanics (2.53 [2.39-2.67]) and Asians (3.89 [3.51-4.32]), and highest among whites (6.46 [6.31-6.61]). Compared with whites, the largest proportion of the disparity among blacks (20%) and AI/ANs (29%) was attributed to measures of predialysis care, while the largest proportion among Hispanics (14%) was attributed to health insurance coverage. Contextual poverty accounted for 16%, 4%, 18%, and 6% of the disparity among blacks, Hispanics, AI/ANs and Pacific Islanders but none of the disparity among Asians. In the United States, significant disparities in rates of LDKT persist, but determinants of these disparities vary by race-ethnicity. Efforts to expand preESKD insurance coverage, to improve access to high-quality predialysis care and to overcome socioeconomic barriers are important targets for addressing disparities in LDKT.

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Figures

Figure 1
Figure 1. Mean unadjusted rates (per 100 person-years) of living (LDKT) and deceased (DDKT) donor kidney transplant by race-ethnicity
Error bars represent the 95% confidence interval for the point estimate.
See this image and copyright information in PMC

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