TY - JOUR
T1 - Association of sociocultural factors with initiation of the kidney transplant evaluation process
AU - Hamoda, Reem E.
AU - McPherson, Laura J.
AU - Lipford, Kristie
AU - Jacob Arriola, Kimberly
AU - Plantinga, Laura
AU - Gander, Jennifer C.
AU - Hartmann, Erica
AU - Mulloy, Laura
AU - Zayas, Carlos F.
AU - Lee, Kyung Na
AU - Pastan, Stephen O.
AU - Patzer, Rachel E.
N1 - Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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.
AB - 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.
KW - disparities
KW - end-stage renal disease
KW - kidney transplant evaluation
KW - race
KW - sociocultural factors
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U2 - 10.1111/ajt.15526
DO - 10.1111/ajt.15526
M3 - Article
C2 - 31278832
AN - SCOPUS:85070739881
SN - 1600-6135
VL - 20
SP - 190
EP - 203
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 1
ER -