title: Racial/Ethnic Differences in the Association Between Hospitalization and Kidney Transplantation Among Waitlisted End-Stage Renal Disease Patients.
abstract: BACKGROUND
  Even after placement on the deceased donor waitlist, there are racial disparities in access to kidney transplant. The association between hospitalization, a proxy for health while waitlisted, and disparities in kidney transplant has not been investigated.
  
  
  METHODS
  We used United States Renal Data System Medicare-linked data on waitlisted end-stage renal disease patients between 2005 and 2009 with continuous enrollment in Medicare Parts A & B (n = 24 581) to examine the association between annual hospitalization rate and odds of receiving a deceased donor kidney transplant. We used multilevel mixed effects models to estimate adjusted odds ratios, controlling for individual-, transplant center-, and organ procurement organization-level clustering.
  
  
  RESULTS
  Blacks and Hispanics were more likely than whites to be hospitalized for circulatory system or endocrine, nutritional, and metabolic diseases (P < 0.001). After adjustment, compared with individuals not hospitalized, patients who were hospitalized frequently while waitlisted were less likely to be transplanted (>2 vs 0 hospitalizations/year adjusted odds ratios = 0.57; P < 0.001). Though blacks and Hispanics were more likely to be hospitalized than whites (P < 0.001), adjusting for hospitalization did not change estimated racial/ethnic disparities in kidney transplantation.
  
  
  CONCLUSIONS
  Individuals hospitalized while waitlisted were less likely to receive a transplant. However, hospitalization does not account for the racial disparity in kidney transplantation after waitlisting.
authors: 1 Department of Epidemiology, Rollins School of Public Health, Atlanta, GA.2 Medical Scientist Training Program, Emory University School of Medicine, Atlanta, GA.3 Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA.4 Emory Transplant Center, Atlanta, GA.5 Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors: Kira L
authors: KL
authors: Newman
authors: Stacey A
authors: SA
authors: Fedewa
authors: Melanie H
authors: MH
authors: Jacobson
authors: Andrew B
authors: AB
authors: Adams
authors: Rebecca
authors: R
authors: Zhang
authors: Stephen O
authors: SO
authors: Pastan
authors: Rachel E
authors: RE
authors: Patzer
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People; D016000:Cluster Analysis; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D051437:Renal Insufficiency / Q000601:surgery*; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods; D014481:United States; D014850:Waiting Lists; D044465:White People; D001741:Black or African American