title: Association of race and insurance type with delayed assessment for kidney transplantation among patients initiating dialysis in the United States.
abstract: OBJECTIVE
  The extent to which racial and socioeconomic disparities in access to kidney transplantation are related to not being assessed for transplant suitability before or shortly after the time of initiation of dialysis is not known. The aims of this study were to determine whether there were disparities based on race, ethnicity, or type of insurance in delayed assessment for transplantation and whether delayed assessment was associated with lower likelihood of waitlisting and kidney transplantation.
  
  
  METHODS
  This retrospective cohort study used data from the US Renal Data System and included 426,489 adult patients beginning dialysis in the United States between January 1, 2005 and September 30, 2009 without prior kidney transplant.
  
  
  RESULTS
  Overall, 12.5% of patients had reportedly not been assessed for transplantation. Patients without private insurance were more likely to be reported as not assessed (multivariable adjusted odds ratio=1.33, 95% confidence interval=1.28-1.40 for Medicaid), with a pronounced racial disparity but no ethnic disparity among patients aged 18 to <35 years (odds ratio=1.27, 95% confidence interval=1.13-1.43; P<0.001 for interaction with age). Not being assessed for transplant around the time of dialysis initiation was associated with lower likelihood of waitlisting in multivariable analysis (hazard ratio=0.59, 95% confidence interval=0.57-0.62 in the first year) and transplantation (hazard ratio=0.46, 95% confidence interval=0.41-0.51 in the first year), especially within the first 2 years.
  
  
  CONCLUSIONS
  Racial and insurance-related disparities in transplant assessment potentially delay transplantation, particularly among younger patients.
authors: US Renal Data System Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, Georgia, USA. johansen@ucsf.edu
authors: Kirsten L
authors: KL
authors: Johansen
authors: Rebecca
authors: R
authors: Zhang
authors: Yijian
authors: Y
authors: Huang
authors: Rachel E
authors: RE
authors: Patzer
authors: Nancy G
authors: NG
authors: Kutner
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007674:Kidney Diseases / Q000208:ethnology / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists; D055815:Young Adult