Association of sociocultural factors with initiation of the kidney transplant evaluation process

Am J Transplant. 2020 Jan;20(1):190-203. doi: 10.1111/ajt.15526. Epub 2019 Aug 14.


Although research shows that minorities exhibit higher levels of medical mistrust, perceived racism, and discrimination in healthcare settings, the degree to which these underlying sociocultural factors preclude end-stage renal disease (ESRD) patients from initiating kidney transplant evaluation is unknown. We telephone surveyed 528 adult ESRD patients of black or white race referred for evaluation to a Georgia transplant center (N = 3) in 2014-2016. We used multivariable logistic regression to examine associations between sociocultural factors and evaluation initiation, adjusting for demographic, clinical, and socioeconomic characteristics. Despite blacks (n = 407) reporting higher levels of medical mistrust (40.0% vs 26.4%, P < .01), perceived racism (55.5% vs 18.2%, P < .01), and experienced discrimination (29.0% vs 15.7%, P < .01) than whites (n = 121), blacks were only slightly less likely than whites to initiate evaluation (49.6% vs 57.9%, P = .11). However, after adjustment, medical mistrust (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.39, 0.91), experienced discrimination (OR: 0.62, 95% CI: 0.41, 0.95), and perceived racism (OR: 0.61; 95% CI: 0.40, 0.92) were associated with lower evaluation initiation. Results suggest that sociocultural disparities exist in early kidney transplant access and occur despite the absence of a significant racial disparity in evaluation initiation. Interventions to reduce disparities in transplantation access should target underlying sociocultural factors, not just race.

Keywords: disparities; end-stage renal disease; kidney transplant evaluation; race; sociocultural factors.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Cross-Sectional Studies
  • Ethnic Groups / psychology*
  • Evaluation Studies as Topic
  • Female
  • Follow-Up Studies
  • Healthcare Disparities*
  • Humans
  • Kidney Failure, Chronic / diagnosis*
  • Kidney Failure, Chronic / psychology
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / psychology
  • Kidney Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Prognosis
  • Socioeconomic Factors*
  • Telephone
  • Trust*