Access to renal transplantation for minority patients with ESRD in Canada.
BACKGROUND
The incidence of end-stage renal disease is increasing worldwide. Renal transplantation generally is the preferred modality of renal replacement therapy; however, in the United States, it is known that minority groups experience decreased access to renal transplantation. It is unknown whether similar differences exist in Canada.


METHODS
Using the Canadian Organ Replacement Register, we identified 25,632 Canadian patients 18 years or older initiating renal replacement therapy during 1990 to 1998. We used Cox regression models to examine adjusted renal transplantation rates among whites, aboriginals, blacks, South Asians, and East Indians during an 8-year period.


RESULTS
Adjusted overall transplantation rates were decreased in comparison to whites for aboriginals (rate ratio [RR], 0.54; 95% confidence interval, 0.45 to 0.63), blacks (RR, 0.54; 95% confidence interval, 0.46 to 0.66), South Asians (RR, 0.69; 95% confidence interval, 0.61 to 0.79), and East Indians (RR, 0.66; 95% confidence interval, 0.56 to 0.78). Race was at least as strong a predictor of transplantation as other known predictors, including age, sex, primary renal diagnosis, and comorbidities. Disparities in renal transplantation rates increased over time from 1990 to 1998 for all racial groups in comparison to whites.


CONCLUSIONS
Renal transplantation rates differ substantially by race in Canada, and these differences appear to be worsening over time. Future work should focus on identifying the specific barriers responsible for these differences in care.
Yeates
Karen E
KE
Division of Nephrology, Queen's University, Kingston, Ontario, Canada. yeatesk@post.queensu.ca
Schaubel
Douglas E
DE
Cass
Alan
A
Sequist
Thomas D
TD
Ayanian
John Z
JZ
D000293:Adolescent; D000328:Adult; D002170:Canada / Q000208:ethnology; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007668:Kidney / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000639:trends*; D008297:Male; D008875:Middle Aged; D008913:Minority Groups