title: Racial disparities in reaching the renal transplant waitlist: is geography as important as race?
abstract: BACKGROUND
  In the United States, African Americans and whites differ in access to the deceased donor renal transplant waitlist. The extent to which racial disparities in waitlisting differ between United Network for Organ Sharing (UNOS) regions is understudied.
  
  
  METHODS
  The US Renal Data System (USRDS) was linked with US census data to examine time from dialysis initiation to waitlisting for whites (n = 188,410) and African Americans (n = 144,335) using Cox proportional hazards across 11 UNOS regions, adjusting for potentially confounding individual, neighborhood, and state characteristics.
  
  
  RESULTS
  Likelihood of waitlisting varies significantly by UNOS region, overall and by race. Additionally, African Americans face significantly lower likelihood of waitlisting compared to whites in all but two regions (1 and 6). Overall, 39% of African Americans with ESRD reside in Regions 3 and 4--regions with a large racial disparity and where African Americans comprise a large proportion of the ESRD population. In these regions, the African American-white disparity is an important contributor to their overall regional disparity.
  
  
  CONCLUSIONS
  Race remains an important factor in time to transplant waitlist in the United States. Race contributes to overall regional disparities; however, the importance of race varies by UNOS region.
authors.affiliation: Department of Medicine, Section of Hospital Medicine, University of Chicago Medical Center, Chicago, IL, USA.|MacLean Center for Clinical Medical Ethics, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Milda R
authors.initials: MR
authors.lastname: Saunders
authors.affiliation: Department of Medicine, Section of Hospital Medicine, University of Chicago Medical Center, Chicago, IL, USA.|Department of Sociology, University of Chicago, Chicago, IL, USA.
authors.forename: Haena
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
authors.affiliation: Department of Health Management and Policy, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, USA.
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Tak
authors.affiliation: Section of Transplantation, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: J Richard
authors.initials: JR
authors.lastname: Thistlethwaite
authors.affiliation: MacLean Center for Clinical Medical Ethics, University of Chicago Medical Center, Chicago, IL, USA.|Section of Transplantation, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.|Department of Pediatrics, University of Chicago Hospitals, Chicago, IL, USA.
authors.forename: Lainie Friedman
authors.initials: LF
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013997:Time Factors; D014481:United States; D014850:Waiting Lists; D044465:White People; D055815:Young Adult
keywords: geographic factors; healthcare disparity; kidney transplant
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