title: Has the Department of Veterans Affairs Found a Way to Avoid Racial Disparities in the Evaluation Process for Kidney Transplantation?
abstract: Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings.
  
  
  
  We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors.
  
  
  
  There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66-0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time.
  
  
  
  Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.
authors.affiliation: 1 Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. 2 Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA. 3 Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 4 Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. 5 Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 6 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA. 7 Department of Psychology, University of Pittsburgh, Pittsburgh, PA. 8 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 9 Renal Section, Tennessee Valley VA Healthcare System, Nashville, TN. 10 Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 11 Kaiser Permanente, Northwest, Portland, OR. 12 Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, OR. 13 Department of Medicine, Oregon Health and Science University, Portland, OR. 14 Renal Section, Pittsburgh VA Healthcare System, Pittsburgh, PA. 15 Renal Section, Iowa City VA Healthcare System, Iowa City, IA. 16 Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Freeman
authors.forename: John R
authors.initials: JR
authors.lastname: Pleis
authors.forename: Kellee R
authors.initials: KR
authors.lastname: Bornemann
authors.forename: Emilee
authors.initials: E
authors.lastname: Croswell
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Chung-Chou H
authors.initials: CH
authors.lastname: Chang
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.forename: Anthony
authors.initials: A
authors.lastname: Langone
authors.forename: Anuja
authors.initials: A
authors.lastname: Mittal-Henkle
authors.forename: Somnath
authors.initials: S
authors.lastname: Saha
authors.forename: Mohan
authors.initials: M
authors.lastname: Ramkumar
authors.forename: Jareen
authors.initials: J
authors.lastname: Adams Flohr
authors.forename: Christie P
authors.initials: CP
authors.lastname: Thomas
authors.forename: Larissa
authors.initials: L
authors.lastname: Myaskovsky
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D000066491:Clinical Decision-Making; D003466:Cultural Characteristics; D004644:Emotions; D005006:Ethnicity / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007407:Interviews as Topic; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology; D010353:Patient Education as Topic; D018579:Patient Selection; D017064:Process Assessment, Health Care; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health / Q000208:ethnology*; D014850:Waiting Lists