title: Modifiable patient characteristics and racial disparities in evaluation completion and living donor transplant.
abstract: OBJECTIVE
  To reduce racial disparities in transplant, modifiable patient characteristics associated with completion of transplant evaluation and receipt of living donor kidney transplant must be identified.
  
  
  METHODS
  From 2004 to 2007, 695 black and white patients were surveyed about 15 less-modifiable and 10 more-modifiable characteristics at evaluation onset; whether they had completed evaluation within 1 year and received living donor kidney transplants by 2010 was determined. Logistic regression and competing risks time-to-event analysis were conducted to determine the variables that predicted evaluation completion and living donor kidney transplant receipt.
  
  
  RESULTS
  Not adjusting for covariates, blacks were less likely than whites to complete evaluation (26.2% versus 51.8%, P<0.001) and receive living donor kidney transplants (8.7% versus 21.9%, P<0.001). More-modifiable variables associated with completing evaluation included more willing to be on the waiting list (odds ratio=3.4, 95% confidence interval=2.1, 5.7), more willing to pursue living donor kidney transplant (odds ratio=2.7, 95% confidence interval=1.8, 4.0), having access to more transplant education resources (odds ratio=2.2, 95% confidence interval=1.5, 3.2), and having greater transplant knowledge (odds ratio=1.8, 95% confidence interval=1.2, 2.7). Patients who started evaluation more willing to pursue living donor kidney transplant (hazard ratio=4.3, 95% confidence interval=2.7, 6.8) and having greater transplant knowledge (hazard ratio=1.2, 95% confidence interval=1.1, 1.3) were more likely to receive living donor kidney transplants.
  
  
  CONCLUSIONS
  Because patients who began transplant evaluation with greater transplant knowledge and motivation were ultimately more successful at receiving transplants years later, behavioral and educational interventions may be very successful strategies to reduce or overcome racial disparities in transplant.
authors.affiliation: Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri 63110, USA. awaterma@dom.wustl.edu
authors.forename: Amy D
authors.initials: AD
authors.lastname: Waterman
authors.forename: John D
authors.initials: JD
authors.lastname: Peipert
authors.forename: Shelley S
authors.initials: SS
authors.lastname: Hyland
authors.forename: Melanie S
authors.initials: MS
authors.lastname: McCabe
authors.forename: Emily A
authors.initials: EA
authors.lastname: Schenk
authors.forename: Jingxia
authors.initials: J
authors.lastname: Liu
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009042:Motivation; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D018579:Patient Selection; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data*