title: Ethnicity, medical insurance, and living kidney donation.
abstract: BACKGROUND
  Relationships between race/ethnicity, recipient medical insurance, and living donor kidney transplantation (LKT) are incompletely described.
  
  
  METHODS
  Associations between medical insurance and LKT were assessed in 447 recipients at a southeastern US transplant center. Primary and secondary payers were included in the analyses.
  
  
  RESULTS
  A total of 387 deceased donor transplantations and 60 LKTs were performed in 246 (55%) European American (EA), 175 (39.2%) African American (AA), 15 (3.4%) Asian, and 11 (2.5%) Hispanic recipients. Among recipients, 182 (40.8%) were privately insured, 125 (28%) had Medicaid, and the remainder had Medicare, Medicare supplements, or Medicare replacement policies. A higher proportion of patients with private insurance, relative to those without private insurance, received LKT (22% vs. 7.6%, p < 0.0001). Among ethnic groups, LKT with, vs. without, private insurance was 27.5% vs. 12.4% in EAs (p = 0.0028) and 14.3% vs. 0.9% in AAs (p = 0.0005). Medicaid recipients (n = 125) were less likely to receive LKT than those without Medicaid (4.8% vs. 16.8%, p = 0.0003). Among the 69 AA recipients with Medicaid, none received LKT (0 Medicaid vs. 9.5% without Medicaid, p = 0.0065).
  
  
  CONCLUSIONS
  Recipient insurance status is associated with LKT, positively with private insurance and negatively with Medicaid. AAs were impacted to a greater extent, potentially contributing to lower rates of LKT.
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157-1053, USA. areeves@wakehealth.edu
authors.forename: Amber Michelle
authors.initials: AM
authors.lastname: Reeves-Daniel
authors.forename: Alan C
authors.initials: AC
authors.lastname: Farney
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Fletcher
authors.forename: Dean
authors.initials: D
authors.lastname: Assimos
authors.forename: Carl
authors.initials: C
authors.lastname: Westcott
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rogers
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: Michael V
authors.initials: MV
authors.lastname: Rocco
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
mesh_terms: D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D007676:Kidney Failure, Chronic / Q000191:economics / Q000208:ethnology / Q000601:surgery*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis
keywords: African American; Medicaid; ethnicity; living donor kidney transplantation; medical insurance