title: Age and sex disparities in discussions about kidney transplantation in adults undergoing dialysis.
abstract: OBJECTIVE
  To explore whether disparities in age and sex in access to kidney transplantation (KT) originate at the time of prereferral discussions about KT.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Outpatient dialysis centers in Maryland (n = 26).
  
  
  METHODS
  Individuals who had recently initiated hemodialysis treatment (N = 416).
  
  
  METHODS
  Participants reported whether medical professionals (nephrologist, primary medical doctor, dialysis staff) and social group members (significant other, family member, friend) discussed KT with them and, when applicable, rated the tone of discussions. Relative risks were estimated using modified Poisson regression.
  
  
  RESULTS
  Participants aged 65 and older were much less likely than those who were younger to have had discussions with medical professionals (44.5% vs 74.8%, P < .001) or social group members (47.3% vs 63.1%, P = .005). Irrespective of sex and independent of race, health-related factors, and dialysis-related characteristics, older adults were more likely not to have had discussions with medical professionals (relative risk (RR) = 1.13, 95% confidence interval (CI) = 1.03-1.24, for each 5-year increase in age through 65; RR = 1.28, 95% CI = 1.14-1.42, for each 5-year increase in age beyond 65). Irrespective of age, women were more likely (RR = 1.45, 95% CI = 1.12-1.89) not to have had discussions with medical professionals. For each 5-year increase in age, men (RR = 1.04, 95% CI = 0.99-1.10) and women (RR = 1.17, 95% CI = 1.10-1.24) were more likely not to have discussions with social group members. Of those who had discussions with medical professionals or social group members, older participants described these discussions as less encouraging (all P < .01).
  
  
  CONCLUSIONS
  Older adults and women undergoing hemodialysis are less likely than younger adults and men to have discussions about KT as a treatment option, supporting a need for better clinical guidelines and education for these individuals, their social network, and their providers.
authors.affiliation: Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland; Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Salter
authors.forename: Mara A
authors.initials: MA
authors.lastname: McAdams-Demarco
authors.forename: Andrew
authors.initials: A
authors.lastname: Law
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Kamil
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Meoni
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sozio
authors.forename: Wen Hong Linda
authors.initials: WH
authors.lastname: Kao
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D003430:Cross-Sectional Studies; D003657:Decision Making; D018450:Disease Progression; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends
keywords: access to transplantation; age disparities; dialysis; kidney transplantation; sex disparities