Racial Disparities and Poverty in Access to Kidney Transplantation Open Access

Patzer, Rachel Elizabeth (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/dj52w485x?locale=en
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Abstract


ABSTRACT

Racial disparities in access to kidney transplantation are evident among End Stage
Renal Disease (ESRD) patients, where black (vs. white) patients are less likely to receive
a transplant. Socioeconomic status (SES) may play a role in both the pediatric and adult
ESRD population. The purpose of this dissertation was to explore the role of poverty and
race in access to kidney transplant among adult and pediatric ESRD patients and to
evaluate the effectiveness of a patient education program at the start of the renal
transplant evaluation process.
Data were abstracted from Emory Transplant Center (ETC) medical records and
linked with data from a national ESRD surveillance system, transplant registry, Census
(2000) and the American Community Survey (2005-2009). Multilevel analytic
approaches were used to examine access to each transplant step by race, testing for effect
modification between race and SES. To examine the effect of an educational intervention
on evaluation completion, we calculated the time-period adjusted probability of
evaluation completion by intervention group and examined the time to evaluation
completion using Cox Proportional Hazards models.
Racial differences in renal transplant access were evident among pediatric and
adult ESRD patients. Among children, black patients were 21% less likely to receive a
transplant compared to whites (HR=0.79; 95% CI: 0.71-0.89). Racial disparities in access
to the deceased donor waiting list were modified by SES, where minority pediatric
patients with no health insurance experienced significant racial disparities, but no
disparities were observed among those with private coverage. Among adults, racial
disparities were observed in several transplant steps, where black patients were 59% less
likely to receive a transplant at any given time vs. whites (HR=0.41; 95% CI: 0.29-0.58).
SES did not explain the racial disparities in either pediatric or adult transplantation. The
implementation of a patient education program increased evaluation completion by 38%
(RR=1.38; 95% CI: 1.12-1.71), and had a stronger effect among black and poor patients.
Findings suggest that earlier access to care may mitigate some racial disparities, but
much of the disparity remains unexplained. Further research is needed to identify
modifiable barriers to improve equitable access to renal transplantation.





Table of Contents



TABLE OF CONTENTS

Chapter 1: Introduction
1

Chapter 2: Background and Literature Review
6

Chapter 3: General Methodological Issues
32

Chapter 4: Dissertation Data Sources

42

Chapter 5: Does Socioeconomic Status Explain the Racial Disparities in
47
Pediatric Access to Kidney Transplantation?

Chapter 6: Race and Access to Renal Transplantation in the Southeastern
77
United States

Chapter 7: Race and Poverty in the Evaluation of a Patient Education
107
Program for Patients Referred for Renal Transplant

Chapter 8: Conclusions and Future Directions
133

References
142

Appendices
161




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