Barriers to cadaveric renal transplantation among blacks, women, and the poor

George Caleb Alexander, Ashwini R. Sehgal

Research output: Contribution to journalArticle

Abstract

Context. - Cadaveric renal transplantation rates differ greatly by race, sex, and income. Previous efforts to lessen these differences have focused on the transplant waiting list. However, the transplantation process involves a series of steps related to medical suitability, interest in transplantation, pretransplant workup, and movement up a waiting list to eventual transplantation. Objective. - To determine the relative importance of each step in explaining differences in cadaveric renal transplantation rates. Design. - Prospective cohort study. Setting and Patients. - A total of 7125 patients beginning long-term dialysis between January 1993 and December 1996 in Indiana, Kentucky, and Ohio. Main Outcome Measures. - Completion of 4 separate steps during each patient-year of follow-up: (A) being medically suitable and possibly interested in transplantation; (B) being definitely interested in transplantation; (C) completing the pretransplant workup; and (D) moving up a waiting list and receiving a transplant. Results. - Compared with whites, blacks were less likely to complete steps B (odds ratio [OR], 0.68; 95% confidence interval [Cl], 0.61-0.76), C (OR, 0.56; 95% Cl, 0.48- 0.65), and D (OR, 0.50; 95% Cl, 0.40-0.62) after adjustment for age, sex, cause of renal failure, years receiving dialysis, and median income of patient ZIP code. Compared with men, women were less likely to complete each of the 4 steps, with ORs of 0 90, 0.89, 0.80, and 0.82, respectively. Poor individuals were less likely than wealthy individuals to complete steps A, B, and C, with ORs of 0.67, 0.78, and 0.77, respectively. Conclusions. - Barriers at several steps are responsible for sociodemographic differences in access to cadaveric renal transplantation. Efforts to allocate kidneys equitably must address each step of the transplant process.

Original languageEnglish (US)
Pages (from-to)1148-1152
Number of pages5
JournalJournal of the American Medical Association
Volume280
Issue number13
DOIs
StatePublished - Oct 7 1998
Externally publishedYes

Fingerprint

Kidney Transplantation
Transplantation
Waiting Lists
Odds Ratio
Transplants
Dialysis
Renal Insufficiency
Cohort Studies
Outcome Assessment (Health Care)
Prospective Studies
Confidence Intervals
Kidney

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Barriers to cadaveric renal transplantation among blacks, women, and the poor. / Alexander, George Caleb; Sehgal, Ashwini R.

In: Journal of the American Medical Association, Vol. 280, No. 13, 07.10.1998, p. 1148-1152.

Research output: Contribution to journalArticle

@article{9c55eb793d5a4e30a330caf13cc22b9f,
title = "Barriers to cadaveric renal transplantation among blacks, women, and the poor",
abstract = "Context. - Cadaveric renal transplantation rates differ greatly by race, sex, and income. Previous efforts to lessen these differences have focused on the transplant waiting list. However, the transplantation process involves a series of steps related to medical suitability, interest in transplantation, pretransplant workup, and movement up a waiting list to eventual transplantation. Objective. - To determine the relative importance of each step in explaining differences in cadaveric renal transplantation rates. Design. - Prospective cohort study. Setting and Patients. - A total of 7125 patients beginning long-term dialysis between January 1993 and December 1996 in Indiana, Kentucky, and Ohio. Main Outcome Measures. - Completion of 4 separate steps during each patient-year of follow-up: (A) being medically suitable and possibly interested in transplantation; (B) being definitely interested in transplantation; (C) completing the pretransplant workup; and (D) moving up a waiting list and receiving a transplant. Results. - Compared with whites, blacks were less likely to complete steps B (odds ratio [OR], 0.68; 95{\%} confidence interval [Cl], 0.61-0.76), C (OR, 0.56; 95{\%} Cl, 0.48- 0.65), and D (OR, 0.50; 95{\%} Cl, 0.40-0.62) after adjustment for age, sex, cause of renal failure, years receiving dialysis, and median income of patient ZIP code. Compared with men, women were less likely to complete each of the 4 steps, with ORs of 0 90, 0.89, 0.80, and 0.82, respectively. Poor individuals were less likely than wealthy individuals to complete steps A, B, and C, with ORs of 0.67, 0.78, and 0.77, respectively. Conclusions. - Barriers at several steps are responsible for sociodemographic differences in access to cadaveric renal transplantation. Efforts to allocate kidneys equitably must address each step of the transplant process.",
author = "Alexander, {George Caleb} and Sehgal, {Ashwini R.}",
year = "1998",
month = "10",
day = "7",
doi = "10.1001/jama.280.13.1148",
language = "English (US)",
volume = "280",
pages = "1148--1152",
journal = "JAMA - Journal of the American Medical Association",
issn = "0098-7484",
publisher = "American Medical Association",
number = "13",

}

TY - JOUR

T1 - Barriers to cadaveric renal transplantation among blacks, women, and the poor

AU - Alexander, George Caleb

AU - Sehgal, Ashwini R.

PY - 1998/10/7

Y1 - 1998/10/7

N2 - Context. - Cadaveric renal transplantation rates differ greatly by race, sex, and income. Previous efforts to lessen these differences have focused on the transplant waiting list. However, the transplantation process involves a series of steps related to medical suitability, interest in transplantation, pretransplant workup, and movement up a waiting list to eventual transplantation. Objective. - To determine the relative importance of each step in explaining differences in cadaveric renal transplantation rates. Design. - Prospective cohort study. Setting and Patients. - A total of 7125 patients beginning long-term dialysis between January 1993 and December 1996 in Indiana, Kentucky, and Ohio. Main Outcome Measures. - Completion of 4 separate steps during each patient-year of follow-up: (A) being medically suitable and possibly interested in transplantation; (B) being definitely interested in transplantation; (C) completing the pretransplant workup; and (D) moving up a waiting list and receiving a transplant. Results. - Compared with whites, blacks were less likely to complete steps B (odds ratio [OR], 0.68; 95% confidence interval [Cl], 0.61-0.76), C (OR, 0.56; 95% Cl, 0.48- 0.65), and D (OR, 0.50; 95% Cl, 0.40-0.62) after adjustment for age, sex, cause of renal failure, years receiving dialysis, and median income of patient ZIP code. Compared with men, women were less likely to complete each of the 4 steps, with ORs of 0 90, 0.89, 0.80, and 0.82, respectively. Poor individuals were less likely than wealthy individuals to complete steps A, B, and C, with ORs of 0.67, 0.78, and 0.77, respectively. Conclusions. - Barriers at several steps are responsible for sociodemographic differences in access to cadaveric renal transplantation. Efforts to allocate kidneys equitably must address each step of the transplant process.

AB - Context. - Cadaveric renal transplantation rates differ greatly by race, sex, and income. Previous efforts to lessen these differences have focused on the transplant waiting list. However, the transplantation process involves a series of steps related to medical suitability, interest in transplantation, pretransplant workup, and movement up a waiting list to eventual transplantation. Objective. - To determine the relative importance of each step in explaining differences in cadaveric renal transplantation rates. Design. - Prospective cohort study. Setting and Patients. - A total of 7125 patients beginning long-term dialysis between January 1993 and December 1996 in Indiana, Kentucky, and Ohio. Main Outcome Measures. - Completion of 4 separate steps during each patient-year of follow-up: (A) being medically suitable and possibly interested in transplantation; (B) being definitely interested in transplantation; (C) completing the pretransplant workup; and (D) moving up a waiting list and receiving a transplant. Results. - Compared with whites, blacks were less likely to complete steps B (odds ratio [OR], 0.68; 95% confidence interval [Cl], 0.61-0.76), C (OR, 0.56; 95% Cl, 0.48- 0.65), and D (OR, 0.50; 95% Cl, 0.40-0.62) after adjustment for age, sex, cause of renal failure, years receiving dialysis, and median income of patient ZIP code. Compared with men, women were less likely to complete each of the 4 steps, with ORs of 0 90, 0.89, 0.80, and 0.82, respectively. Poor individuals were less likely than wealthy individuals to complete steps A, B, and C, with ORs of 0.67, 0.78, and 0.77, respectively. Conclusions. - Barriers at several steps are responsible for sociodemographic differences in access to cadaveric renal transplantation. Efforts to allocate kidneys equitably must address each step of the transplant process.

UR - http://www.scopus.com/inward/record.url?scp=0032494410&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032494410&partnerID=8YFLogxK

U2 - 10.1001/jama.280.13.1148

DO - 10.1001/jama.280.13.1148

M3 - Article

C2 - 9777814

AN - SCOPUS:0032494410

VL - 280

SP - 1148

EP - 1152

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0098-7484

IS - 13

ER -