Linguistic Isolation and Access to the Active Kidney Transplant Waiting List in the United States.
OBJECTIVE
Waitlist inactivity is a barrier to transplantation, because inactive candidates cannot receive deceased donor organ offers. We hypothesized that temporarily inactive kidney transplant candidates living in linguistically isolated communities would be less likely to achieve active waitlist status.


METHODS
We merged Organ Procurement and Transplantation Network/United Network for Organ Sharing data with five-digit zip code socioeconomic data from the 2000 US Census. The cumulative incidence of conversion to active waitlist status, death, and delisting before conversion among 84,783 temporarily inactive adult kidney candidates from 2004 to 2012 was determined using competing risks methods. Competing risks regression was performed to characterize the association between linguistic isolation, incomplete transplantation evaluation, and conversion to active status. A household was determined to be linguistically isolated if all members ≥14 years old speak a non-English language and also, speak English less than very well.


RESULTS
A total of 59,147 candidates (70% of the study population) achieved active status over the study period of 9.8 years. Median follow-up was 110 days (interquartile range, 42-276 days) for activated patients and 815 days (interquartile range, 361-1244 days) for candidates not activated. The cumulative incidence of activation over the study period was 74%, the cumulative incidence of death before conversion was 10%, and the cumulative incidence of delisting was 13%. After adjusting for other relevant covariates, living in a zip code with higher percentages of linguistically isolated households was associated with progressively lower subhazards of activation both in the overall population (reference: <1% linguistically isolated households; 1%-4.9% linguistically isolated: subhazard ratio, 0.89; 95% confidence interval, 0.86 to 0.93; 5%-9.9% linguistically isolated: subhazard ratio, 0.83; 95% confidence interval, 0.80 to 0.87; 10%-19.9% linguistically isolated: subhazard ratio, 0.76; 95% confidence interval, 0.72 to 0.80; and ≥20% linguistically isolated: subhazard ratio, 0.71; 95% confidence interval, 0.67 to 0.76) and among candidates designated temporarily inactive due to an incomplete transplant evaluation.


CONCLUSIONS
Our findings indicate that candidates residing in linguistically isolated communities are less likely to complete candidate evaluations and achieve active waitlist status.
Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California.
Efrain
E
Talamantes
Division of Nephrology, Department of Medicine.|Division of General Internal Medicine and Health Services, Department of Medicine, and.
Keith C
KC
Norris
Division of General Internal Medicine and Health Services, Department of Medicine, and.
Carol M
CM
Mangione
Department of Family Medicine, and.
Gerardo
G
Moreno
Division of Nephrology, Department of Medicine.|Kidney Transplant Research Program, Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and.
Amy D
AD
Waterman
Division of Nephrology, Department of Medicine.|Kidney Transplant Research Program, Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and.
John D
JD
Peipert
Division of Nephrology, Department of Medicine.|Kidney Transplant Research Program, Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and.
Suphamai
S
Bunnapradist
Division of Nephrology, Department of Medicine.|Kidney Transplant Research Program, Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and.|Division of Nephrology, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California.
Edmund
E
Huang
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D019352:Censuses; D003144:Communication Barriers; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D007802:Language; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data
ethnicity; kidney transplantation; language; race; waitlist