title: Disparities in completion rates of the medical prerenal transplant evaluation by race or ethnicity and gender.
abstract: BACKGROUND
  A significant number of potential kidney transplant candidates do not complete the required medical evaluation after referral to a transplant program.
  
  
  METHODS
  Factors associated with rate of completion of the renal transplant evaluation were analyzed using a retrospective chart review of patients first seen between October 1, 2009, and September 30, 2010 (n=256). The primary endpoint was completion in 12 months. Independent variables included socioeconomic, demographic, and medical factors.
  
  
  RESULTS
  Mean age was 50.7 years; 49.6% were black, 28.5% Hispanic, and 21.9% white and other; 26.3% did not require dialysis. During follow-up, 23.4% did not complete the evaluation. Multivariable analysis indicated that slower rates of completion were associated with needing a greater number of medical tests (compared to 0-2: 3-5 tests, hazard ratio [HR]=0.65, P=0.02; ≥ 6 tests, HR=0.47, P=0.0005) and requiring more than one hospitalization (compared to none: HR=0.37, P=0.0008). A significant interaction between race or ethnicity and gender on completion was found: compared to black men, Hispanic men (HR=2.75, P<0.0001), Hispanic women (HR=1.96, P=0.006), and white men (HR=1.99, P=0.005) showed a more rapid completion. In comparison, black and white women (HR=1.38, P=0.16; HR=0.94, P=0.83, respectively) were not significantly different from black men in rates of completion. Differences by race or ethnicity and gender were not confounded by socioeconomic variables or social support.
  
  
  CONCLUSIONS
  To lessen barriers and facilitate renal transplantation, black men and women, white women, and patients needing multiple medical tests and requiring several hospitalizations may benefit from additional assistance during the medical evaluation process.
authors.affiliation: 1 Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL. 2 Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Monson
authors.forename: Patricia
authors.initials: P
authors.lastname: Kemerley
authors.forename: Douglas
authors.initials: D
authors.lastname: Walczak
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
authors.forename: Jose
authors.initials: J
authors.lastname: Oberholzer
authors.forename: Kirstie K
authors.initials: KK
authors.lastname: Danielson
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D002641:Chicago; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000208:ethnology* / Q000523:psychology*; D011300:Preoperative Care; D016016:Proportional Hazards Models; D044469:Racial Groups / Q000523:psychology*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D044465:White People / Q000523:psychology