title: Ethnic Background Is a Potential Barrier to Living Donor Kidney Transplantation in Canada: A Single-Center Retrospective Cohort Study.
abstract: We examined if African or Asian ethnicity was associated with lower access to kidney transplantation (KT) in a Canadian setting.
  
  
  
  Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, who completed social work assessment, were included (n = 1769). The association between ethnicity and the time from referral to completion of KT evaluation or receipt of a KT were examined using Cox proportional hazards models.
  
  
  
  About 54% of the sample was white, 13% African, 11% East Asian, and 11% South Asian; 7% had "other" (n = 121) ethnic background. African Canadians (hazard ratio [HR], 0.75; 95% CI: 0.62-0.92]) and patients with "other" ethnicity (HR, 0.71; 95% CI, 0.55-0.92) were less likely to complete the KT evaluation compared with white Canadians, and this association remained statistically significant in multivariable adjusted models. Access to KT was significantly reduced for all ethnic groups assessed compared with white Canadians, and this was primarily driven by differences in access to living donor KT. The adjusted HRs for living donor KT were 0.35 (95% CI, 0.24-0.51), 0.27 (95% CI, 0.17-0.41), 0.43 (95% CI, 0.30-0.61), and 0.34 (95% CI, 0.20-0.56) for African, East or South Asian Canadians and for patients with "other" ethnic background, respectively.
  
  
  
  Similar to other jurisdictions, nonwhite patients face barriers to accessing KT in Canada. This inequity is very substantial for living donor KT. Further research is needed to identify if these inequities are due to potentially modifiable barriers.
authors.affiliation: 1 Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada. 2 Division of Nephrology, David Geffen School of Medicine at the University of California, Los Angeles, CA. 3 Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto Toronto, Ontario, Canada. 4 Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary. 5 Institute of Health Policy, Management and Evaluation, University of Toronto Toronto, Ontario, Canada.
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.forename: Aarushi
authors.initials: A
authors.lastname: Bansal
authors.forename: Olusegun
authors.initials: O
authors.lastname: Famure
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.forename: Margot
authors.initials: M
authors.lastname: Mitchell
authors.forename: Amy D
authors.initials: AD
authors.lastname: Waterman
authors.forename: Marta
authors.initials: M
authors.lastname: Novak
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D044466:Asian People; D044383:Black People; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006769:Hospitals, General; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario / Q000453:epidemiology; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014850:Waiting Lists; D044465:White People