Association of Socioeconomic Status and Comorbidities with Racial Disparities during Kidney Transplant Evaluation.

Autor:	Murphy KA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland., Jackson JW; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Purnell TS; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland., Shaffer AA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland., Haugen CE; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland., Chu NM; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland., Crews DC; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland.; Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland., Norman SP; Division of Nephrology, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan., Segev DL; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland., McAdams-DeMarco MA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2020 Jun 08; Vol. 15 (6), pp. 843-851. Date of Electronic Publication: 2020 May 07.
DOI:	10.2215/CJN.12541019
Abstrakt:	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 ( n =1452 black; n =1561 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 (self-reported 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 black versus 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. (Copyright © 2020 by the American Society of Nephrology.)
Databáze:	MEDLINE
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