Racial/Ethnic Differences in the Association Between Hospitalization and Kidney Transplantation Among Waitlisted End-Stage Renal Disease Patients

• Authors: Kira L. Newman, Rollins School of Public Health; Stacey A Fedewa, Rollins School of Public Health; Melanie H. Jacobson, Rollins School of Public Health; Andrew B. Adams, Emory University; Rebecca Zhang, Emory University; Stephen Pastan, Emory University; Rachel Elizabeth Patzer, Emory University
• Journal Title: Transplantation
• Volume: Volume 100, Number 12
• Publisher: Lippincott, Williams & Wilkins | 2016-12-01, Pages 2735-2745
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/TP.0000000000001072
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Surgery; Transplantation; 30-DAY READMISSION RATES; QUALITY-OF-LIFE; UNITED-STATES; RACIAL DISPARITIES; WAITING TIME; MEDICARE BENEFICIARIES; ACCESS; RACE; DONOR; OUTCOMES

Abstract

Background Even after placement on the deceased donor waitlist, there are racial disparities in access to kidney transplant. The association between hospitalization, a proxy for health while waitlisted, and disparities in kidney transplant has not been investigated. Methods We used United States Renal Data System Medicare-linked data on waitlisted end-stage renal disease patients between 2005 and 2009 with continuous enrollment in Medicare Parts A & B (n = 24 581) to examine the association between annual hospitalization rate and odds of receiving a deceased donor kidney transplant. We used multilevel mixed effects models to estimate adjusted odds ratios, controlling for individual-, transplant center-, and organ procurement organization-level clustering. Results Blacks and Hispanics were more likely than whites to be hospitalized for circulatory system or endocrine, nutritional, and metabolic diseases (P < 0.001). After adjustment, compared with individuals not hospitalized, patients who were hospitalized frequently while waitlisted were less likely to be transplanted ( > 2 vs 0 hospitalizations/year adjusted odds ratios = 0.57; P < 0.001). Though blacks and Hispanics were more likely to be hospitalized than whites (P < 0.001), adjusting for hospitalization did not change estimated racial/ethnic disparities in kidney transplantation. Conclusions Individuals hospitalized while waitlisted were less likely to receive a transplant. However, hospitalization does not account for the racial disparity in kidney transplantation after waitlisting.