Intersectional Sex and Race Disparities in Provision of Kidney Transplant Education and Subsequent Access to Waitlisting and Transplantation Restricted; Files Only
Hugo, Alyssa Jesse (Spring 2026)
Abstract
Background
Disparities in access to kidney transplantation exist by race, sex, and their intersection. This study examines intersectional racial and gender differences in the provision of transplant education, an early step in the transplant care continuum.
Methods
All adults (aged 18 to <80 years) initiating dialysis between January 2015 and September 2018 were identified from the United States Renal Data System. Intersectional sex*race groups include White men, White women, Black men, Black women, Hispanic men, Hispanic women, “other” race men, and “other” race women. Primary outcomes include being informed kidney transplantation (yes/no) and ‘psychologically unfit’ (yes/no) as the reason for not being informed. Secondary outcomes include waitlisting, receiving a living donor transplantation (LDKT), and a deceased donor transplantation (DDKT). Associations between sex, race, and primary outcomes were analyzed using crude odds ratios (ORs) and 95% confidence intervals (CIs). Associations between sex, race, provision of transplant information, and secondary outcomes were analyzed using Cox proportional hazards models (hazard ratios; HRs) and 95% CIs.
Results
Among 401,907 patients, the proportion of patients not informed of transplant varied by sex*race groups, ranging from 8.7% among Hispanic men to 12.2% among White women. Compared with White men, White women had the highest odds of not being informed (OR: 1.07 [95% CI: 1.04, 1.10]). Overall, informed (vs. uninformed) patients were more likely to be waitlisted across sex*race groups, slightly more likely to receive a LDKT, and similarly likely to receive a DDKT among waitlisted patients. Among those not informed, between 2% and 5% were classified as psychologically unfit across sex*race groups. Black men had 26% higher odds of being deemed psychologically unfit than White men (OR: 1.26 [1.03–1.53]). Black men deemed psychologically unfit were then 87% less likely to be waitlisted than Black men not receiving education for other reasons (HR: 0.13 [0.04, 0.39]).
Conclusion
Transplant education disparities are unevenly distributed across populations and likely reflect how intersecting patient, provider, and system-level factors shape access and subsequent outcomes. Efforts to improve equity in transplant education should consider both race and gender to address overlapping disparities early in the care continuum.
Table of Contents
I. Literature Review .......................................................................................1
II. Introduction ...............................................................................................12
III. Methods .....................................................................................................13
IV. Results ........................................................................................................19
V. Discussion ..................................................................................................38
VI. References ..................................................................................................44
VII. Supplementary ............................................................................................52
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File download under embargo until 21 May 2028 | 2026-04-22 20:56:14 -0400 | File download under embargo until 21 May 2028 |
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