Sex/Gender-Based Disparities in Early Transplant Access by Attributed Cause of Kidney Disease–Evidence from a Multiregional Cohort in the Southeast United States

• Type of Material: Article
• Authors: Jessica Harding, Emory University; Mengyu Di, Emory University; Stephen Pastan, Emory University; Ana Rossi, Piedmont Transplant Institute; Annika Gompers, Emory University; Rachel Elizabeth Patzer, Emory University; Derek DuBay, Medical University of South Carolina
• Language: English
• Date: 2023-09-09
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2023 International Society of Nephrology. Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016/j.ekir.2023.09.010
• Title of Journal or Parent Work: Kidney International Reports
• Volume: 8
• Issue: 12
• Start Page: 2580
• End Page: 2591
• Grant/Funding Information: This project and The Reducing Disparities in Access to kidNey Transplantation Regional Study was funded in part by a National Institute on Minority Health and Health Disparities award U01MD010611, a National Institute of Diabetes and Digestive and Kidney Diseases award R01DK122701, and an Emory University Health Services Center Pilot Award. Support for the preparation of this document was funded by the Centers for Medicare and Medicaid Services (an agency of the US Department of Health and Human Services) End-Stage Renal Disease Network 6 contract HHSM-500-2013-NW006C.
• Keywords: health services research; kidney transplant; epidemiology; gender disparities; transplant referral
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Introduction We examined sex/gender disparities across the continuum of transplant care by attributed cause of end-stage kidney disease (ESKD). Methods All adults (18–79 years; N = 43,548) with new-onset ESKD in Georgia, North Carolina, or South Carolina between 2015 and 2019 were identified from the United States Renal Data System (USRDS). Individuals were linked to the Early Steps to Transplant Access Registry (E-STAR) to obtain data on referral and evaluation. Waitlisting data was ascertained from USRDS. Using a Cox-proportional hazards model, with follow-up through 2020, we assessed the association between sex/gender and referral within 12 months (among all incident dialysis patients), evaluation start within 6 months (among referred patients), and waitlisting (among all evaluated patients) by attributed cause of ESKD (type 1 diabetes mellitus, type 2 diabetes mellitus, hypertension, glomerulonephritis, cystic disease, and other). Results Overall, women (vs. men) with type 2 diabetes-attributed ESKD were 13% (crude hazard ratio [HR]: 0.87 [0.83–0.91]), 14% (crude HR: 0.86 [0.81–0.91]), and 14% (crude HR: 0.86 [0.78–0.94]) less likely to be referred, evaluated, and waitlisted, respectively. Women (vs. men) with hypertension-attributed ESKD were 14% (crude HR: 0.86 [0.82–0.90]) and 8% (crude HR: 0.92 [0.87–0.98]) less likely to be referred and evaluated, respectively, but similarly likely to be waitlisted once evaluated (crude HR: 1.06 [0.97–1.15]). For all other attributed causes of ESKD, there was no sex/gender disparity in referral, evaluation, or waitlisting rates. Conclusion In the Southeast United States, sex/gender disparities in early access to kidney transplantation are specific to people with ESKD attributed to type 2 diabetes and hypertension.