Association of sociocultural factors with initiation of the kidney transplant evaluation process

• Type of Material: Article
• Authors: Reem E Hamoda, Emory University; Laura J McPherson, Emory University; Kristie Lipford, Emory University; Kimberly Jacob Arriola, Emory University; Laura Plantinga, Emory University; Jennifer C Gander, Kaiser Permanente; Erica Hartmann, Piedmont Transplant Institute; Laura Mulloy, Augusta University; Carlos F Zayas, Augusta University; Kyung Na Lee, Emory University; Stephen Pastan, Emory University; Rachel Patzer, Emory University
• Language: English
• Date: 2019-08-14
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.15526
• Title of Journal or Parent Work: AMERICAN JOURNAL OF TRANSPLANTATION
• Volume: 20
• Issue: 1
• Start Page: 190
• End Page: 203
• Grant/Funding Information: National Institute of Minority Health and Health Disparities, Grant/Award Number: U01MD010611
• Keywords: Science & Technology; STAGE RENAL-DISEASE; disparities; RACIAL DISPARITIES; SHARED DECISION-MAKING; Life Sciences & Biomedicine; RACE; end-stage renal disease; AFRICAN-AMERICAN; ACCESS; Surgery; race; kidney transplant evaluation; CARE; sociocultural factors; SATISFACTION; Transplantation; MISTRUST; DIALYSIS

Abstract

Although research shows that minorities exhibit higher levels of medical mistrust, perceived racism, and discrimination in healthcare settings, the degree to which these underlying sociocultural factors preclude end-stage renal disease (ESRD) patients from initiating kidney transplant evaluation is unknown. We telephone surveyed 528 adult ESRD patients of black or white race referred for evaluation to a Georgia transplant center (N = 3) in 2014-2016. We used multivariable logistic regression to examine associations between sociocultural factors and evaluation initiation, adjusting for demographic, clinical, and socioeconomic characteristics. Despite blacks (n = 407) reporting higher levels of medical mistrust (40.0% vs 26.4%, P <.01), perceived racism (55.5% vs 18.2%, P <.01), and experienced discrimination (29.0% vs 15.7%, P <.01) than whites (n = 121), blacks were only slightly less likely than whites to initiate evaluation (49.6% vs 57.9%, P =.11). However, after adjustment, medical mistrust (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.39, 0.91), experienced discrimination (OR: 0.62, 95% CI: 0.41, 0.95), and perceived racism (OR: 0.61; 95% CI: 0.40, 0.92) were associated with lower evaluation initiation. Results suggest that sociocultural disparities exist in early kidney transplant access and occur despite the absence of a significant racial disparity in evaluation initiation. Interventions to reduce disparities in transplantation access should target underlying sociocultural factors, not just race.