Social Determinants of Health and Race Disparities in Kidney Transplant

Background and objectives Black patients have a higher incidence of kidney failure but lower rate of deceased- and living-donor kidney transplantation comparedwithWhite patients, even after taking differences in comorbidities into account. We assessed whether social determinants of health (e.g., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living- donor kidney transplantation. Design, setting, participants,& measurements Viamedical record review, we prospectively followed 1056 patients referred for kidney transplant (2010-2012), who completed an interviewsoon after kidney transplant evaluation, until their kidney transplant. We usedmultivariable competing riskmodels to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome. Results Even after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to theKidneyAllocation System, greater religiosity, less social support, less transplant knowledge, andfewer learningactivitieswere each associatedwitha lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, and fewer learning activities were each associated with a lower probability of deceased-donor transplant. Black race, older age, lower income, public insurance, higher bodymass index, dialysis before kidney transplant, not presentingwith apotential living donor, religious objection to living-donor transplant, and less transplant knowledge were each associated with a lower probability of living-donor transplant. Conclusions Race and social determinants of health are associated with the likelihood of undergoing kidney transplant.

Automated summary

Even after considering social determinants of health, Black patients have a lower likelihood of kidney transplant.