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Racial disparities in reaching the renal transplant waitlist: is geography as important as race?
Author(s) -
Saunders Milda R.,
Lee Haena,
Alexander G. Caleb,
Tak Hyo Jung,
Thistlethwaite J. Richard,
Ross Lainie Friedman
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12547
Subject(s) - medicine , race (biology) , demography , census , dialysis , confounding , population , health equity , united network for organ sharing , gerontology , transplantation , public health , environmental health , pathology , botany , sociology , biology , liver transplantation
Background In the U nited S tates, A frican A mericans and whites differ in access to the deceased donor renal transplant waitlist. The extent to which racial disparities in waitlisting differ between U nited N etwork for O rgan S haring ( UNOS ) regions is understudied. Methods The US R enal D ata S ystem ( USRDS ) was linked with US census data to examine time from dialysis initiation to waitlisting for whites (n = 188 410) and African Americans (n = 144 335) using C ox proportional hazards across 11 UNOS regions, adjusting for potentially confounding individual, neighborhood, and state characteristics. Results Likelihood of waitlisting varies significantly by UNOS region, overall and by race. Additionally, African Americans face significantly lower likelihood of waitlisting compared to whites in all but two regions (1 and 6). Overall, 39% of African Americans with ESRD reside in R egions 3 and 4 – regions with a large racial disparity and where African Americans comprise a large proportion of the ESRD population. In these regions, the A frican A merican–white disparity is an important contributor to their overall regional disparity. Conclusions Race remains an important factor in time to transplant waitlist in the U nited S tates. Race contributes to overall regional disparities; however, the importance of race varies by UNOS region.