title: Young aboriginals are less likely to receive a renal transplant: a Canadian national study.
abstract: BACKGROUND
  Previous studies have demonstrated Aboriginals are less likely to receive a renal transplant in comparison to Caucasians however whether this applies to the entire population or specific subsets remains unclear. We examined the effect of age on renal transplantation in Aboriginals.
  
  
  METHODS
  Data on 30,688 dialysis (Aboriginal 2,361, Caucasian 28, 327) patients obtained between Jan. 2000 and Dec. 2009 were included in the final analysis. Racial status was self-reported. Cox proportional hazards, the Fine and Grey sub-distribution method and Poisson regression were used to determine the association between race, age and transplantation.
  
  
  RESULTS
  In comparison to Caucasians, Aboriginals were less likely to receive a renal transplant (Adjusted HR 0.66 95% CI 0.57-0.77, P < 0.0001) however after stratification by age and treating death as a competing outcome, the effect was more predominant in younger Aboriginals (Age 18-40: 20.6% aboriginals vs. 48.3% Caucasians transplanted; aHR 0.50(0.39-0.61), p < 0.0001, Age 41-50: 10.2% aboriginals vs. 33.9% Caucasians transplanted; aHR 0.46(0.32-0.64), p = 0.005, Age 51-60: 8.2% aboriginals vs. 19.5% Caucasians transplanted; aHR0.65(0.49-0.88), p = 0.01, Age >60: 2.7% aboriginals vs. 2.6% Caucasians transplanted; aHR 1.21(0.76-1.91), P = 0.4, Age X race interaction p < 0.0001). Both living and deceased donor transplants were lower in Aboriginals under the age of 60 compared to Caucasians.
  
  
  CONCLUSIONS
  Younger Aboriginals are less likely to receive a renal transplant compared to their Caucasian counterparts, even after adjustment for comorbidity. Determination of the reasons behind these discrepancies and interventions specifically targeting the Aboriginal population are warranted.
authors: Department of Medicine, Section of Nephrology, St Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg R2H 2A6, Canada.
authors: Steven
authors: S
authors: Promislow
authors: Brenda
authors: B
authors: Hemmelgarn
authors: Claudio
authors: C
authors: Rigatto
authors: Navdeep
authors: N
authors: Tangri
authors: Paul
authors: P
authors: Komenda
authors: Leroy
authors: L
authors: Storsley
authors: Karen
authors: K
authors: Yeates
authors: Julie
authors: J
authors: Mojica
authors: Manish M
authors: MM
authors: Sood
mesh_terms: D000368:Aged; D044467:American Indian or Alaska Native / Q000706:statistics & numerical data*; D002170:Canada / Q000453:epidemiology; D005260:Female; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000208:ethnology* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D044465:White People / Q000706:statistics & numerical data*