Disparities among Blacks, Hispanics, and Whites in time from starting dialysis to kidney transplant waitlisting

Transplantation. 2013 Jan 27;95(2):309-18. doi: 10.1097/TP.0b013e31827191d4.

Abstract

Background: Although a longer time on dialysis before kidney transplant waitlisting has been shown for Blacks versus non-Blacks, relatively few studies have compared this outcome between Hispanics and Whites.

Methods: A multivariable analysis of 1910 (684 Black, 452 Hispanic, and 774 White) consecutive patients waitlisted at our center for a primary kidney transplant between 2005 and mid-2010 was performed for time from starting dialysis to waitlisting (months), the percentage who were preemptively waitlisted (waitlisted before starting dialysis), and time from starting dialysis to waitlisting after excluding the preemptively waitlisted patients.

Results: The variables associated with significantly longer median times from starting dialysis to waitlisting and less preemptive waitlisting included Medicare insurance for patients ages <65 years (by far, the most significant variable in each analysis), Black race, higher percentage of households in the patient's zip code living in poverty, being a non-U.S. citizen (for preemptive waitlisting), Medicaid insurance, waitlisted for kidney-alone (vs. kidney-pancreas) transplant, and higher body mass index (longer median times for the latter three variables). Although the effect of Black race was mostly explained by significant associations with lower socioeconomic status (Medicare insurance for patients ages <65 years and greater poverty in the patient's zip code), an unexplained component still remained. The univariable differences showing poorer outcomes for Hispanics versus Whites were smaller and completely explained in multivariable analysis by significant associations with lower socioeconomic status and non-U.S. citizenship.

Conclusion: Black and Hispanic patients had significantly longer times from starting dialysis to waitlisting, in large part related to their lower socioeconomic status and less preemptive waitlisting. A greater focus on earlier nephrology care may help to erase much of these disparities.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • African Americans* / statistics & numerical data
  • Age Factors
  • Aged
  • Body Mass Index
  • Chi-Square Distribution
  • Emigrants and Immigrants
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Health Services Accessibility* / statistics & numerical data
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data
  • Hispanic Americans* / statistics & numerical data
  • Humans
  • Kidney Failure, Chronic / ethnology
  • Kidney Failure, Chronic / surgery
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation / ethnology*
  • Kidney Transplantation / statistics & numerical data
  • Linear Models
  • Logistic Models
  • Male
  • Medicaid
  • Medicare
  • Middle Aged
  • Multivariate Analysis
  • Poverty / ethnology
  • Renal Dialysis* / statistics & numerical data
  • Residence Characteristics
  • Socioeconomic Factors*
  • Time Factors
  • United States / epidemiology
  • Waiting Lists*
  • Young Adult