TY - JOUR
T1 - Association of socioeconomic status and comorbidities With racial disparities during kidney transplant evaluation
AU - Murphy, Karly A.
AU - Jackson, John W.
AU - Purnell, Tanjala S.
AU - Shaffer, Ashton A.
AU - Haugen, Christine E.
AU - Chu, Nadia M.
AU - Crews, Deidra C.
AU - Norman, Silas P.
AU - Segev, Dorry L.
AU - McAdams-Demarco, Mara A.
N1 - Funding Information:
This study Was funded by National Institutes of Health grants R01-AG042504 (principal investigator [PI]: Dr. Segev), K24DK101828 (PI: Dr. Segev), and R01-AG055781 (PI: Dr. McAdamsDeMarco), and by Agency for Healthcare Research and Quality grant K01HS024600 (PI: Dr. Purnell). Dr. Murphy Was supported by National Heart, Lung, and Blood Institute grant 2T32HL00718041A. Dr. Jackson Was supported by National Heart, Lung, and Blood Institute grant K01HL145320. Dr. Shaffer Was supported by National Institute of Diabetes and Digestive and Kidney Diseases grant F30DK116658. Dr. Haugen Was supported byNational Institute of Aging grant F32AG05302.
Funding Information:
This study was funded by National Institutes of Health grants R01-AG042504 (principal investigator [PI]: Dr. Segev), K24-DK101828 (PI: Dr. Segev), and R01-AG055781 (PI: Dr. McAdams-DeMarco), and by Agency for Healthcare Research and Quality grant K01HS024600 (PI: Dr. Purnell). Dr. Murphy was supported by National Heart, Lung, and Blood Institute grant 2T32HL007180-41A. Dr. Jackson was supported by National Heart, Lung, and Blood Institute grant K01HL145320. Dr. Shaffer was supported by National Institute of Diabetes and Digestive and Kidney Diseases grant F30DK116658. Dr. Haugen was supported by National Institute of Aging grant F32AG05302.
Publisher Copyright:
© 2020 by the American Society of Nephrology.
PY - 2020/6/8
Y1 - 2020/6/8
N2 - Background and objectives Black patients referred for kidney transplantation have surpassed many obstacles but likely face continued racial disparities before transplant. The mechanisms that underlie these disparities are unclear. We determined the contributions of socioeconomic status (SES) and comorbidities as mediators to disparities in listing and transplant. Design, setting, participants, & measurements We studied a cohort (n51452 black; n51561 White) of patients With kidney failure Who Were referred for and started the transplant process (2009–2018). We estimated the direct and indirect effects of SES (self-reported income, education, and employment) and medical comorbidities (selfreported and chart-abstracted) as mediators of racial disparities in listing using Cox proportional hazards analysis With inverse odds ratio Weighting. Among the 983 black and 1085 White candidates actively listed, We estimated the direct and indirect effects of SES and comorbidities as mediators of racial disparities on receipt of transplant using Poisson regression With inverse odds ratio Weighting. Results Within the first year, 876 (60%) black and 1028 (66%) White patients Were Waitlisted. The relative risk of listing for black compared With White patients Was 0.76 (95% confidence interval [95% CI], 0.69 to 0.83); after adjustment for SES and comorbidity, the relative risk Was 0.90 (95% CI, 0.83 to 0.97). The proportion of the racial disparity in listing Was explained by SES by 36% (95% CI, 26% to 57%), comorbidity by 44% (95% CI, 35% to 61%), and SES With comorbidity by 58% (95% CI, 44% to 85%). There Were 409 (42%) black and 496 (45%) White listed candidates transplanted, With a median duration of follow-up of 3.9 (interquartile range, 1.2–7.1) and 2.8 (interquartile range, 0.8–6.3) years, respectively. The incidence rate ratio for blackversus White candidates Was 0.87 (95% CI, 0.79 to 0.96); SES and comorbidity did not explain the racial disparity. Conclusions SES and comorbidity partially mediated racial disparities in listing but not for transplant.
AB - Background and objectives Black patients referred for kidney transplantation have surpassed many obstacles but likely face continued racial disparities before transplant. The mechanisms that underlie these disparities are unclear. We determined the contributions of socioeconomic status (SES) and comorbidities as mediators to disparities in listing and transplant. Design, setting, participants, & measurements We studied a cohort (n51452 black; n51561 White) of patients With kidney failure Who Were referred for and started the transplant process (2009–2018). We estimated the direct and indirect effects of SES (self-reported income, education, and employment) and medical comorbidities (selfreported and chart-abstracted) as mediators of racial disparities in listing using Cox proportional hazards analysis With inverse odds ratio Weighting. Among the 983 black and 1085 White candidates actively listed, We estimated the direct and indirect effects of SES and comorbidities as mediators of racial disparities on receipt of transplant using Poisson regression With inverse odds ratio Weighting. Results Within the first year, 876 (60%) black and 1028 (66%) White patients Were Waitlisted. The relative risk of listing for black compared With White patients Was 0.76 (95% confidence interval [95% CI], 0.69 to 0.83); after adjustment for SES and comorbidity, the relative risk Was 0.90 (95% CI, 0.83 to 0.97). The proportion of the racial disparity in listing Was explained by SES by 36% (95% CI, 26% to 57%), comorbidity by 44% (95% CI, 35% to 61%), and SES With comorbidity by 58% (95% CI, 44% to 85%). There Were 409 (42%) black and 496 (45%) White listed candidates transplanted, With a median duration of follow-up of 3.9 (interquartile range, 1.2–7.1) and 2.8 (interquartile range, 0.8–6.3) years, respectively. The incidence rate ratio for blackversus White candidates Was 0.87 (95% CI, 0.79 to 0.96); SES and comorbidity did not explain the racial disparity. Conclusions SES and comorbidity partially mediated racial disparities in listing but not for transplant.
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U2 - 10.2215/CJN.12541019
DO - 10.2215/CJN.12541019
M3 - Article
C2 - 32381582
AN - SCOPUS:85086914013
SN - 1555-9041
VL - 15
SP - 843
EP - 851
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 6
ER -