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. 2024 Jul;38(7):e15395.
doi: 10.1111/ctr.15395.

Medical Distrust Among Kidney Transplant Candidates

Valerie L Thompson  1 , Yiting Li  2 , Yi Liu  2 , Jingyao Hong  2 , Swati Sharma  2 , Garyn Metoyer  2 , Maya N Clark-Cutaia  3 , Tanjala S Purnell  1   4 , Deidra C Crews  5 , Dorry L Segev  2   6 , Mara McAdams-DeMarco  2   6
Affiliations

Medical Distrust Among Kidney Transplant Candidates

Valerie L Thompson et al. Clin Transplant. 2024 Jul.

Abstract

Background: Medical distrust may hinder kidney transplantation (KT) access. Among KT candidates evaluated for waitlisting, we identified factors associated with high distrust levels and quantified their association with waitlisting.

Methods: Among 812 candidates (2018-2023), we assessed distrust using the Revised Health Care System Distrust Scale across composite, competence, and values subscales. We used linear regression to quantify the associations between candidate and neighborhood-level factors and distrust scores. We used Cox models to quantify the associations between distrust scores and waitlisting.

Results: At KT evaluation, candidates who were aged 35-49 years (difference = 1.97, 95% CI: 0.78-3.16), female (difference = 1.10, 95% CI: 0.23-1.97), and Black (difference = 1.47, 95% CI: 0.47-2.47) were more likely to report higher composite distrust score. For subscales, candidates aged 35-49 were more likely to have higher competence distrust score (difference = 1.14, 95% CI: 0.59-1.68) and values distrust score (difference = 0.83, 95% CI: 0.05-1.61). Race/ethnicity (Black, difference = 1.42, 95% CI: 0.76-2.07; Hispanic, difference = 1.52, 95% CI: 0.35-2.69) was only associated with higher values distrust scores. Female candidates reporting higher rescaled values distrust scores (each one point) had a lower chance of waitlisting (aHR = 0.78, 95% CI: 0.63-0.98), whereas this association was not observed among males. Similarly, among non-White candidates, each 1-point increase in both rescaled composite (aHR = 0.87, 95% CI: 0.77-0.99) and values (aHR = 0.82, 95% CI: 0.68-0.99) distrust scores was associated with a lower chance of waitlisting, while there was no association among White candidates.

Conclusion: Female, younger, and non-White candidates reported higher distrust scores. Values distrust may contribute to the long-standing racial/ethnic and gender disparities in access to KT. Implementing tailored strategies to reduce distrust in transplant care may improve KT access for groups that experience persistent disparities.

Keywords: disparities; kidney transplant; kidney transplant evaluation; medical distrust.

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Conflict of interest statement

Conflicts of Interest Statement: The authors of this manuscript have no conflicts of interest to disclose.

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