Perceived discrimination predicts longer time to be accepted for kidney transplant.
BACKGROUND
Although end-stage kidney disease in African Americans (AAs) is four times greater than in whites, AAs are less than one half as likely to undergo kidney transplantation (KT). This racial disparity has been found even after controlling for clinical factors such as comorbid conditions, dialysis vintage and type, and availability of potential living donors. Therefore, studying nonmedical factors is critical to understanding disparities in KT.


METHODS
We conducted a longitudinal cohort study with 127 AA and white patients with end-stage kidney disease undergoing evaluation for KT (December 2006 to July 2007) to determine whether, after controlling for medical factors, differences in time to acceptance for transplant is explained by patients' cultural factors (e.g., perceived racism and discrimination, medical mistrust, religious objections to living donor KT), psychosocial characteristics (e.g., social support, anxiety, depression), or transplant knowledge. Participants completed two telephone interviews (shortly after initiation of transplant evaluation and after being accepted or found ineligible for transplant).


RESULTS
Results indicated that AA patients reported higher levels of the cultural factors than did whites. We found no differences in comorbidity or availability of potential living donors. AAs took significantly longer to get accepted for transplant than did whites (hazard ratio=1.49, P=0.005). After adjustment for demographic, psychosocial, and cultural factors, the association of race with longer time for listing was no longer significant.


CONCLUSIONS
We suggest that interventions to address racial disparities in KT incorporate key nonmedical risk factors in patients.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA. larissa.myaskovsky@va.gov
Larissa
L
Myaskovsky
Donna
D
Almario Doebler
Donna M
DM
Posluszny
Mary Amanda
MA
Dew
Mark
M
Unruh
Linda F
LF
Fried
Galen E
GE
Switzer
Sunghee
S
Kim
Chung-Chou H
CC
Chang
Mohan
M
Ramkumar
Ron
R
Shapiro
D000328:Adult; D001741:Black or African American; D015331:Cohort Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000208:ethnology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D011584:Psychology; D012067:Religion; D012307:Risk Factors; D013997:Time Factors; D014850:Waiting Lists; D044465:White People