Effect of education on racial disparities in access to kidney transplantation

Clin Transplant. Jan-Feb 2012;26(1):74-81. doi: 10.1111/j.1399-0012.2010.01390.x. Epub 2010 Dec 27.


Higher education level might result in reduced disparities in access to renal transplantation. We analyzed two outcomes: (i) being placed on the waiting list or transplanted without listing and (ii) transplantation in patients who were placed on the waiting list. We identified 3224 adult patients with end-stage renal disease (ESRD) in United States Renal Data System with education information available (mean age of ESRD onset of 57.1 ± 16.2 yr old, 54.3% men, 64.2% white, and 50.4% diabetics). Compared to whites, fewer African Americans graduated from college (10% vs. 16.7%) and a higher percentage never graduated from the high school (38.6% vs. 30.8%). African American race was associated with reduced access to transplantation (hazard ratio [HR] 0.70, p < 0.001 for wait-listing/transplantation without listing; HR 0.58, p < 0.001 for transplantation after listing). African American patients were less likely to be wait-listed/transplanted in the three less-educated groups: HR 0.67 (p = 0.005) for those never completed high school, HR 0.76 (p = 0.02) for high school graduates, and HR 0.65 (p = 0.003) for those with partial college education. However, the difference lost statistical significance in those who completed college education (HR 0.75, p = 0.1). In conclusion, in comparing white and African American candidates, racial disparities in access to kidney transplantation do exist. However, they might be alleviated in highly educated individuals.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data*
  • Educational Status
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Health Status Disparities
  • Healthcare Disparities*
  • Humans
  • Kidney Failure, Chronic / ethnology*
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Patient Education as Topic*
  • Prognosis
  • Retrospective Studies
  • Waiting Lists
  • Young Adult