Effect of Neighborhood-Level English Proficiency on Initial Kidney Transplant Registration and Interaction by Rural / Urban Residence Open Access

Darius, Amandha (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/3197xn29m?locale=en


Despite kidney transplantation being the preferred method of renal replacement therapy for end-stage renal disease patients, patients of minority background continue to experience disparities in waitlist registration. It is known that language barriers impede access to healthcare, but these barriers have not been extensively addressed at the neighborhood level, nor have the differential effects of rural vs urban status on these barriers. We assess the association between neighborhood-level English proficiency and likelihood of patients to register on the kidney transplant waitlist, and we examine potential effect modification by rural vs urban status. In this retrospective cohort study, we use data from the most recent American Community Survey to determine ZIP-code level English proficiency. A Cox procedure stratified by rural vs. non-rural status was used to measure time to waitlisting among adult ESRD patients in the United States Renal Data System (USRDS) from 2013 to 2017, controlling neighborhood socioeconomic status, and for individual factors such as race, Hispanic ethnicity, age, sex, and BMI. Among non-rural patients, patients in the second quintile of LEP (0.6 – 1.6%) were 9% more likely to be waitlisted than those in the lowest quintile of LEP (0 – 0.5%) (HR = 1.09, 95% CI 1.01 – 1.18). This association was not present among other quintiles of LEP considered to be non-rural, and was not present for rural patients at all. These results suggest that neighborhood English proficiency alone does not explain disparities in waitlisting, but rather that neighborhood socioeconomic status and individual demographic factors may explain this relationship.

Table of Contents

Introduction 1

Methods 4

Results 9

Discussion 11

References 15

Tables 21

Figures/Figure Legends 25

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  • English
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