Association of Race and Age on Transplant Waitlisting among Incident ESKD Patients in the United States Pubblico

Abstract

Background: Racial disparities exist in access to kidney transplantation, and older patients have reduced access to the national transplant waiting list. However, it is unknown whether racial disparities in waitlisting differ by age. We examined whether age modifies racial disparities in placement on the national transplant waitlist.

Methods: Non-Hispanic White (NHW) and non-Hispanic Black (NHB) adults that initiated ESKD treatment between 2015 and 2018 and were followed through 2020 were identified from the US Renal Data System. Age was categorized as 18-29, 30-49, 50-64, and 65-80. The incidence of waitlisting overall and by race and age was calculated. Age- and race-stratified waitlisting rates were compared and age was examined as an effect modifier in multivariable-adjusted Cox proportional hazards models accounting for the competing risk of death.

Results: Overall, 19.4% of patients were waitlisted, including 19.1% NHB and 19.5% NHW patients. Waitlisting was higher among younger patients (51% overall; 60% NHW, 40% NHB). For patients 65-80, 9% were waitlisted overall, including 8% NHW and 9% NHB. Overall, in unadjusted analysis, NHB patients had lower waitlisting rates (HR: 0.87, 95% CI, 0.85, 0.88). After stratifying by age and adjusting for demographic and clinical characteristics, NHB patients had significantly lower waitlisting rates than their NHW counterparts between 18-29 years (aHR: 0.74, 95% CI, 0.69, 0.80), 30-49 (aHR: 0.89, 95% CI, 0.86, 0.92), 50-64 (aHR: 0.89, 95% CI, 0.86, 0.91), and 65-80 (aHR: 0.82, 95% CI: 0.79, 0.86); p <.001 for interaction terms.

Conclusions: Racial disparities in waitlisting exist between NHB and NHW adult patients with incident ESKD undergoing dialysis treatment. This disparity is more pronounced among the youngest age group and less evident among patients ≥30.

Table of Contents

Introduction -------------------------------------------------------------------------------------------------1

Methods -----------------------------------------------------------------------------------------------------2

Study population, data sources, and exclusion criteria ------------------------------------------------------2

Study Variables ----------------------------------------------------------------------------------------------3

Statistical Analyses ------------------------------------------------------------------------------------------4

Subgroup Analysis-------------------------------------------------------------------------------------------5

Results ------------------------------------------------------------------------------------------------------6

Study Population Characteristics ---------------------------------------------------------------------------6

Placement on the Deceased Donor Waitlist for Transplant by Race -----------------------------------------6

Age-Stratified Analyses -------------------------------------------------------------------------------------7

Subgroup Analyses Among 18–29-Year-Olds ---------------------------------------------------------------8

Discussion --------------------------------------------------------------------------------------------------9

References -------------------------------------------------------------------------------------------------15

Tables and Figures -----------------------------------------------------------------------------------------18

Table 1.-----------------------------------------------------------------------------------------------------18

Table 2.-----------------------------------------------------------------------------------------------------21

Table 3.-----------------------------------------------------------------------------------------------------22

Table 4.-----------------------------------------------------------------------------------------------------23

Table 5.-----------------------------------------------------------------------------------------------------24

Figure 1.----------------------------------------------------------------------------------------------------25

Figure 2a. --------------------------------------------------------------------------------------------------26

Figure 2b. --------------------------------------------------------------------------------------------------27

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Parola chiave	socioeconomic factors age disparities kidney transplant waitlist kidney transplant racial disparities end-stage kidney disease access to transplantation
Committee Chair / Thesis Advisor	Patzer, Rachel Elizabeth , Emory University
Committee Members	Retzloff, Samantha, Emory University

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