title: Consistency of racial variation in medical outcomes among publicly and privately insured living kidney donors.
abstract: BACKGROUND
  Racial disparities in health outcomes after living donation have been reported, but generalizability is not known.
  
  
  METHODS
  We linked Organ Procurement and Transplantation Network (OPTN) registry data for 4,007 living kidney donors in 1987 to 2008 with Medicare billing claims (2000-2008). Cox regression with left and right censoring was used to estimate the frequencies and relative risks of postdonation medical diagnoses according to race. Patterns were compared with findings from a previous linkage of OPTN donor records and private insurance claims.
  
  
  RESULTS
  Among the Medicare-insured donors, 8% were African American and 5.7% were Hispanic. Diagnosis frequencies at 5 years after donation in the Medicare- versus privately insured donors included the following: malignant hypertension, 5.0% versus 0.9%; diabetes, 18.5% versus 4.1%; and chronic kidney disease, 21.8% versus 4.9%. After age and sex adjustment in the Medicare sample, African Americans, as compared with white donors, experienced higher risks of any hypertension diagnosis, including 2.4 times the likelihood of malignant hypertension (adjusted hazard ratio [aHR], 2.35; 95% confidence interval [CI], 1.40-3.93), and more common diabetes (aHR, 1.50; 95% CI, 1.12-2.04), chronic kidney disease (aHR, 1.84; 95% CI, 1.37-2.47), and proteinuria (aHR, 2.44; 95% CI, 1.45-4.11) diagnoses. Relative patterns for privately insured African American versus white donors were similar, including approximately three times the risk of malignant hypertension (aHR, 3.27; 95% CI, 1.82-5.88) and twice the relative risks of chronic kidney disease and proteinuria.
  
  
  CONCLUSIONS
  Consistent demonstration of racial variation in postdonation medical conditions regardless of sample/payer source supports the need for continued study of mediators and consequences of outcomes in non-white donors.
authors.affiliation: 1 Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO. 2 Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO. 3 Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH. 4 Division of Nephrology, Western University, London, Canada. 5 Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 6 Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD. 7 Address correspondence to: Krista L. Lentine, M.D., Ph.D., Saint Louis University Center for Outcomes Research, Salus Center 4th Floor, 3545 Lafayette Ave, St. Louis, MO 63104.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health; D016030:Kidney Transplantation / Q000191:economics*; D019520:Living Donors; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012042:Registries; D009927:Tissue and Organ Procurement / Q000191:economics* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States