Disparities among blacks, hispanics, and whites in time from starting dialysis to kidney transplant waitlisting

Shivam Joshi, Jeffrey J. Gaynor, Stephanie Bayers, Giselle Guerra, Ahmed Eldefrawy, Zoila Chediak, Lazara Companioni, Junichiro Sageshima, Linda Chen, Warren Kupin, David Roth, Adela Mattiazzi, George W. Burke, Gaetano Ciancio

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

BACKGROUND: Although a longer time on dialysis before kidney transplant waitlisting has been shown for Blacks versus non-Blacks, relatively few studies have compared this outcome between Hispanics and Whites. METHODS: A multivariable analysis of 1910 (684 Black, 452 Hispanic, and 774 White) consecutive patients waitlisted at our center for a primary kidney transplant between 2005 and mid-2010 was performed for time from starting dialysis to waitlisting (months), the percentage who were preemptively waitlisted (waitlisted before starting dialysis), and time from starting dialysis to waitlisting after excluding the preemptively waitlisted patients. RESULTS: The variables associated with significantly longer median times from starting dialysis to waitlisting and less preemptive waitlisting included Medicare insurance for patients ages <65 years (by far, the most significant variable in each analysis), Black race, higher percentage of households in the patient's zip code living in poverty, being a non-U.S. citizen (for preemptive waitlisting), Medicaid insurance, waitlisted for kidney-alone (vs. kidney-pancreas) transplant, and higher body mass index (longer median times for the latter three variables). Although the effect of Black race was mostly explained by significant associations with lower socioeconomic status (Medicare insurance for patients ages <65 years and greater poverty in the patient's zip code), an unexplained component still remained. The univariable differences showing poorer outcomes for Hispanics versus Whites were smaller and completely explained in multivariable analysis by significant associations with lower socioeconomic status and non-U.S. citizenship. CONCLUSION: Black and Hispanic patients had significantly longer times from starting dialysis to waitlisting, in large part related to their lower socioeconomic status and less preemptive waitlisting. A greater focus on earlier nephrology care may help to erase much of these disparities.

Original languageEnglish (US)
Pages (from-to)309-318
Number of pages10
JournalTransplantation
Volume95
Issue number2
DOIs
StatePublished - Jan 27 2013
Externally publishedYes

Fingerprint

Hispanic Americans
Dialysis
Transplants
Kidney
Insurance
Social Class
Poverty
Medicare
Nephrology
Medicaid
hydroquinone
Pancreas
Body Mass Index

Keywords

  • Blacks
  • Dialysis
  • Hispanics
  • Kidney transplant waitlisting
  • Preemptive waitlisting
  • Time from starting dialysis to waitlisting.

ASJC Scopus subject areas

  • Transplantation

Cite this

Joshi, S., Gaynor, J. J., Bayers, S., Guerra, G., Eldefrawy, A., Chediak, Z., ... Ciancio, G. (2013). Disparities among blacks, hispanics, and whites in time from starting dialysis to kidney transplant waitlisting. Transplantation, 95(2), 309-318. https://doi.org/10.1097/TP.0b013e31827191d4

Disparities among blacks, hispanics, and whites in time from starting dialysis to kidney transplant waitlisting. / Joshi, Shivam; Gaynor, Jeffrey J.; Bayers, Stephanie; Guerra, Giselle; Eldefrawy, Ahmed; Chediak, Zoila; Companioni, Lazara; Sageshima, Junichiro; Chen, Linda; Kupin, Warren; Roth, David; Mattiazzi, Adela; Burke, George W.; Ciancio, Gaetano.

In: Transplantation, Vol. 95, No. 2, 27.01.2013, p. 309-318.

Research output: Contribution to journalArticle

Joshi, S, Gaynor, JJ, Bayers, S, Guerra, G, Eldefrawy, A, Chediak, Z, Companioni, L, Sageshima, J, Chen, L, Kupin, W, Roth, D, Mattiazzi, A, Burke, GW & Ciancio, G 2013, 'Disparities among blacks, hispanics, and whites in time from starting dialysis to kidney transplant waitlisting', Transplantation, vol. 95, no. 2, pp. 309-318. https://doi.org/10.1097/TP.0b013e31827191d4
Joshi, Shivam ; Gaynor, Jeffrey J. ; Bayers, Stephanie ; Guerra, Giselle ; Eldefrawy, Ahmed ; Chediak, Zoila ; Companioni, Lazara ; Sageshima, Junichiro ; Chen, Linda ; Kupin, Warren ; Roth, David ; Mattiazzi, Adela ; Burke, George W. ; Ciancio, Gaetano. / Disparities among blacks, hispanics, and whites in time from starting dialysis to kidney transplant waitlisting. In: Transplantation. 2013 ; Vol. 95, No. 2. pp. 309-318.
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abstract = "BACKGROUND: Although a longer time on dialysis before kidney transplant waitlisting has been shown for Blacks versus non-Blacks, relatively few studies have compared this outcome between Hispanics and Whites. METHODS: A multivariable analysis of 1910 (684 Black, 452 Hispanic, and 774 White) consecutive patients waitlisted at our center for a primary kidney transplant between 2005 and mid-2010 was performed for time from starting dialysis to waitlisting (months), the percentage who were preemptively waitlisted (waitlisted before starting dialysis), and time from starting dialysis to waitlisting after excluding the preemptively waitlisted patients. RESULTS: The variables associated with significantly longer median times from starting dialysis to waitlisting and less preemptive waitlisting included Medicare insurance for patients ages <65 years (by far, the most significant variable in each analysis), Black race, higher percentage of households in the patient's zip code living in poverty, being a non-U.S. citizen (for preemptive waitlisting), Medicaid insurance, waitlisted for kidney-alone (vs. kidney-pancreas) transplant, and higher body mass index (longer median times for the latter three variables). Although the effect of Black race was mostly explained by significant associations with lower socioeconomic status (Medicare insurance for patients ages <65 years and greater poverty in the patient's zip code), an unexplained component still remained. The univariable differences showing poorer outcomes for Hispanics versus Whites were smaller and completely explained in multivariable analysis by significant associations with lower socioeconomic status and non-U.S. citizenship. CONCLUSION: Black and Hispanic patients had significantly longer times from starting dialysis to waitlisting, in large part related to their lower socioeconomic status and less preemptive waitlisting. A greater focus on earlier nephrology care may help to erase much of these disparities.",
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AU - Joshi, Shivam

AU - Gaynor, Jeffrey J.

AU - Bayers, Stephanie

AU - Guerra, Giselle

AU - Eldefrawy, Ahmed

AU - Chediak, Zoila

AU - Companioni, Lazara

AU - Sageshima, Junichiro

AU - Chen, Linda

AU - Kupin, Warren

AU - Roth, David

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AU - Burke, George W.

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N2 - BACKGROUND: Although a longer time on dialysis before kidney transplant waitlisting has been shown for Blacks versus non-Blacks, relatively few studies have compared this outcome between Hispanics and Whites. METHODS: A multivariable analysis of 1910 (684 Black, 452 Hispanic, and 774 White) consecutive patients waitlisted at our center for a primary kidney transplant between 2005 and mid-2010 was performed for time from starting dialysis to waitlisting (months), the percentage who were preemptively waitlisted (waitlisted before starting dialysis), and time from starting dialysis to waitlisting after excluding the preemptively waitlisted patients. RESULTS: The variables associated with significantly longer median times from starting dialysis to waitlisting and less preemptive waitlisting included Medicare insurance for patients ages <65 years (by far, the most significant variable in each analysis), Black race, higher percentage of households in the patient's zip code living in poverty, being a non-U.S. citizen (for preemptive waitlisting), Medicaid insurance, waitlisted for kidney-alone (vs. kidney-pancreas) transplant, and higher body mass index (longer median times for the latter three variables). Although the effect of Black race was mostly explained by significant associations with lower socioeconomic status (Medicare insurance for patients ages <65 years and greater poverty in the patient's zip code), an unexplained component still remained. The univariable differences showing poorer outcomes for Hispanics versus Whites were smaller and completely explained in multivariable analysis by significant associations with lower socioeconomic status and non-U.S. citizenship. CONCLUSION: Black and Hispanic patients had significantly longer times from starting dialysis to waitlisting, in large part related to their lower socioeconomic status and less preemptive waitlisting. A greater focus on earlier nephrology care may help to erase much of these disparities.

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