title: Effect of education on racial disparities in access to kidney transplantation.
abstract: Higher education level might result in reduced disparities in access to renal transplantation. We analyzed two outcomes: (i) being placed on the waiting list or transplanted without listing and (ii) transplantation in patients who were placed on the waiting list. We identified 3224 adult patients with end-stage renal disease (ESRD) in United States Renal Data System with education information available (mean age of ESRD onset of 57.1 ± 16.2 yr old, 54.3% men, 64.2% white, and 50.4% diabetics). Compared to whites, fewer African Americans graduated from college (10% vs. 16.7%) and a higher percentage never graduated from the high school (38.6% vs. 30.8%). African American race was associated with reduced access to transplantation (hazard ratio [HR] 0.70, p < 0.001 for wait-listing/transplantation without listing; HR 0.58, p < 0.001 for transplantation after listing). African American patients were less likely to be wait-listed/transplanted in the three less-educated groups: HR 0.67 (p = 0.005) for those never completed high school, HR 0.76 (p = 0.02) for high school graduates, and HR 0.65 (p = 0.003) for those with partial college education. However, the difference lost statistical significance in those who completed college education (HR 0.75, p = 0.1). In conclusion, in comparing white and African American candidates, racial disparities in access to kidney transplantation do exist. However, they might be alleviated in highly educated individuals.
authors.affiliation: Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. agoldfar@bidmc.harvard.edu
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Goldfarb-Rumyantzev
authors.forename: Gurprataap S
authors.initials: GS
authors.lastname: Sandhu
authors.forename: Bradley
authors.initials: B
authors.lastname: Baird
authors.forename: Anna
authors.initials: A
authors.lastname: Barenbaum
authors.forename: Joo Heung
authors.initials: JH
authors.lastname: Yoon
authors.forename: Noelle
authors.initials: N
authors.lastname: Dimitri
authors.forename: James K
authors.initials: JK
authors.lastname: Koford
authors.forename: Fuad
authors.initials: F
authors.lastname: Shihab
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011379:Prognosis; D012189:Retrospective Studies; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult