Rhiannon D Reed1, Deirdre Sawinski2, Brittany A Shelton1, Paul A MacLennan1, Michael Hanaway1, Vineeta Kumar3, Dustin Long4, Robert S Gaston3, Meredith L Kilgore5, Bruce A Julian3, Cora E Lewis6, Jayme E Locke1. 1. Department of Surgery, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL. 2. Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3. Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL. 4. Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL. 5. Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, AL. 6. Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Abstract
BACKGROUND: Living donor kidney transplantation has declined in the United States since 2004, but the relationship between population characteristics and rate of living donation is unknown. The goal of our study was to use data on general population health and socioeconomic status to investigate the association with living donation. METHODS: This cross-sectional, ecological study used population health and socioeconomic status data from the CDC Behavioral Risk Factor Surveillance System to investigate the association with living donation. Transplant centers performing 10 or greater kidney transplants reported to the Scientific Registry of Transplant Recipients in 2015 were included. Center rate of living donation was defined as the proportion of all kidney transplants performed at a center that were from living donors. RESULTS: In a linear mixed-effects model, a composite index of health and socioeconomic status factors was negatively associated with living donation, with a rate of living donation that was on average 7.3 percentage points lower among centers in areas with more comorbid disease and poorer socioeconomic status (95% confidence interval, -12.2 to -2.3, P = 0.004). Transplant centers in areas with higher prevalence of minorities had a rate of living donation that was 7.1 percentage points lower than centers with fewer minorities (95% confidence interval, -11.8 to -2.3, P = 0.004). CONCLUSIONS: Center-level variation in living donation was associated with population characteristics and minority prevalence. Further examination of these factors in the context of patient and center-level barriers to living donation is warranted.
BACKGROUND: Living donor kidney transplantation has declined in the United States since 2004, but the relationship between population characteristics and rate of living donation is unknown. The goal of our study was to use data on general population health and socioeconomic status to investigate the association with living donation. METHODS: This cross-sectional, ecological study used population health and socioeconomic status data from the CDC Behavioral Risk Factor Surveillance System to investigate the association with living donation. Transplant centers performing 10 or greater kidney transplants reported to the Scientific Registry of Transplant Recipients in 2015 were included. Center rate of living donation was defined as the proportion of all kidney transplants performed at a center that were from living donors. RESULTS: In a linear mixed-effects model, a composite index of health and socioeconomic status factors was negatively associated with living donation, with a rate of living donation that was on average 7.3 percentage points lower among centers in areas with more comorbid disease and poorer socioeconomic status (95% confidence interval, -12.2 to -2.3, P = 0.004). Transplant centers in areas with higher prevalence of minorities had a rate of living donation that was 7.1 percentage points lower than centers with fewer minorities (95% confidence interval, -11.8 to -2.3, P = 0.004). CONCLUSIONS: Center-level variation in living donation was associated with population characteristics and minority prevalence. Further examination of these factors in the context of patient and center-level barriers to living donation is warranted.
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