The role of race and poverty on steps to kidney transplantation in the Southeastern United States

Am J Transplant. 2012 Feb;12(2):358-68. doi: 10.1111/j.1600-6143.2011.03927.x. Epub 2012 Jan 10.


Racial disparities in access to renal transplantation exist, but the effects of race and socioeconomic status (SES) on early steps of renal transplantation have not been well explored. Adult patients referred for renal transplant evaluation at a single transplant center in the Southeastern United States from 2005 to 2007, followed through May 2010, were examined. Demographic and clinical data were obtained from patient's medical records and then linked with United States Renal Data System and American Community Survey Census data. Cox models examined the effect of race on referral, evaluation, waitlisting and organ receipt. Of 2291 patients, 64.9% were black, the mean age was 49.4 years and 33.6% lived in poor neighborhoods. Racial disparities were observed in access to referral, transplant evaluation, waitlisting and organ receipt. SES explained almost one-third of the lower rate of transplant among black versus white patients, but even after adjustment for demographic, clinical and SES factors, blacks had a 59% lower rate of transplant than whites (hazard ratio = 0.41; 95% confidence interval: 0.28-0.58). Results suggest that improving access to healthcare may reduce some, but not all, of the racial disparities in access to kidney transplantation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Health Status Disparities*
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Kidney Failure, Chronic / ethnology
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / ethnology*
  • Kidney Transplantation / statistics & numerical data
  • Male
  • Middle Aged
  • Poverty*
  • Racial Groups*
  • Retrospective Studies
  • Socioeconomic Factors
  • Southeastern United States / epidemiology
  • Waiting Lists*
  • Young Adult