Medical Distrust Among Kidney Transplant Candidates.

Autor: Thompson VL; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Li Y; Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA., Liu Y; Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA., Hong J; Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA., Sharma S; Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA., Metoyer G; Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA., Clark-Cutaia MN; Rory Meyers College of Nursing, New York University, New York, New York, USA., Purnell TS; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Crews DC; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Segev DL; Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA.; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA., McAdams-DeMarco M; Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA.; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Jul; Vol. 38 (7), pp. e15395.
DOI: 10.1111/ctr.15395
Abstrakt: 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.
(© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: