Access to renal transplantation among American Indians and Hispanics.
BACKGROUND
African Americans have decreased access to renal transplantation compared with whites. Whether similar barriers exist for American Indians or Hispanics is not well defined.


METHODS
The authors identified a total of 1,335 patients ages 20 to 59 years without prior renal transplantation undergoing dialysis in December 1994 in Arizona and New Mexico. For each patient, information was collected on identification as a potential candidate for renal transplantation, referral to a renal transplantation center, completion of 4 stages in the evaluation process, and receipt of a transplant over 7 years.


RESULTS
American Indians were more likely than whites to be identified as potential candidates (relative risk [RR] 1.30, 95% confidence interval [CI] 1.15 to 1.44) and to be referred to a transplant center (RR 1.16, 95% CI 1.09 to 1.19). There were no significant differences in candidacy or referral status between Hispanics and whites. Among potential candidates referred to a transplant center, both American Indians (RR 0.73, 95% CI 0.51 to 0.96) and Hispanics (RR 0.68, 95% CI 0.50 to 0.88) were less likely than whites to be placed on a waiting list. Both American Indians (hazard ratio [HR] 0.37, 95% CI 0.24 to 0.58) and Hispanics (HR 0.58, 95% CI 0.39 to 0.86) were much less likely than whites to undergo renal transplantation.


CONCLUSIONS
Despite similar referral rates for renal transplantation, American Indians and Hispanics were less likely than whites to be placed on a transplant waiting list or receive a transplant. Policies to address these disparities should address specific barriers within the transplant evaluation process.
Sequist
Thomas D
TD
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Narva
Andrew S
AS
Stiles
Sharon K
SK
Karp
Shelley K
SK
Cass
Alan
A
Ayanian
John Z
JZ
D000328:Adult; D001130:Arizona / Q000453:epidemiology; D000075202:Contraindications; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000523:psychology / Q000706:statistics & numerical data*; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000601:surgery; D016030:Kidney Transplantation / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009516:New Mexico / Q000453:epidemiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018579:Patient Selection; D011287:Prejudice; D011584:Psychology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000523:psychology; D012959:Socioeconomic Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data; D014850:Waiting Lists; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data