Racial disparities in access to simultaneous pancreas-kidney transplantation in the United States

Am J Kidney Dis. 2000 Sep;36(3):526-33. doi: 10.1053/ajkd.2000.9793.

Abstract

The purpose of our study is to assess the extent of racial differences in the access to simultaneous pancreas-kidney (SPK) transplantation and evaluate the potential influence of socioeconomic factors on access to transplantation. We performed a retrospective analysis of the US Renal Data System and United Network for Organ Sharing data on all patients with end-stage renal disease (ESRD) due to diabetes mellitus from 1988 to 1996 (n = 562, 814), including all dialysis, wait list, and transplant patients. Racial differences in incidence, prevalence, insurance coverage, employment status, and transplantation rates were calculated. Caucasians had the highest prevalence of ESRD caused by type 1 diabetes (73%), followed by blacks (22%), Hispanics (3%), Native Americans (2%), and others (<1%). Both blacks and Native Americans increased their annual incidence of ESRD caused by insulin-dependent diabetes mellitus by 10% compared with only a 3.5% increase in Caucasians, whereas incidence rates increased annually by almost 8% for both blacks and Native Americans compared with a 3% increase for Caucasians. However, Caucasians received 92% of all SPK transplants, whereas all other racial groups combined received a disproportionate minority of the remaining transplants. Lack of private insurance and unemployment status were associated with annual changes in both incidence of ESRD caused by type 1 diabetes and SPK transplant rates. In conclusion, we observed striking racial disparities for access to SPK transplantation in the United States today, which may be related to employment status, access to private insurance, and subsequent health care. Our preliminary data support current efforts to encourage Medicare and Medicaid coverage for all patients requiring SPK transplantation regardless of racial or financial status.

MeSH terms

  • African Americans / statistics & numerical data
  • Asian Americans / statistics & numerical data
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / ethnology*
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / ethnology*
  • Diabetic Nephropathies / surgery*
  • Employment / statistics & numerical data
  • Ethnic Groups / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Incidence
  • Indians, North American / statistics & numerical data
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / ethnology*
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / statistics & numerical data*
  • Pancreas Transplantation / statistics & numerical data*
  • Prevalence
  • Retrospective Studies
  • Socioeconomic Factors
  • United States / epidemiology
  • United States / ethnology