Michael A Freeman1, John R Pleis, Kellee R Bornemann, Emilee Croswell, Mary Amanda Dew, Chung-Chou H Chang, Galen E Switzer, Anthony Langone, Anuja Mittal-Henkle, Somnath Saha, Mohan Ramkumar, Jareen Adams Flohr, Christie P Thomas, Larissa Myaskovsky. 1. 1 Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. 2 Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA. 3 Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 4 Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. 5 Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 6 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA. 7 Department of Psychology, University of Pittsburgh, Pittsburgh, PA. 8 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 9 Renal Section, Tennessee Valley VA Healthcare System, Nashville, TN. 10 Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 11 Kaiser Permanente, Northwest, Portland, OR. 12 Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, OR. 13 Department of Medicine, Oregon Health and Science University, Portland, OR. 14 Renal Section, Pittsburgh VA Healthcare System, Pittsburgh, PA. 15 Renal Section, Iowa City VA Healthcare System, Iowa City, IA. 16 Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
Abstract
BACKGROUND: Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. METHODS: We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. RESULTS: There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66-0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. CONCLUSIONS: Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.
BACKGROUND: Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. METHODS: We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. RESULTS: There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66-0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. CONCLUSIONS: Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.
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