Fewer Race Disparities in the National VA Kidney Transplant Program.

Abstract

African Americans (AA) take significantly longer to complete evaluation, be accepted for kidney transplant (KT), and have poorer quality of life (QOL) outcomes than do Whites (WH). VA procedures for KT evaluation are markedly different from other US transplant centers. We collected primary data from patients in all VA KT centers to: (a) compare rates of KT acceptance, time to KT acceptance, and QOL between AA & WH Veterans; and (b) assess if demographics, cultural factors (e.g., perceived discrimination, medical mistrust), psychosocial characteristics (e.g., anxiety, depression), and transplant knowledge (TK) predict time to acceptance. Multi-site, prospective study that recruited the majority of Veterans evaluated for KT within the National VA KT System. Patients completed telephone interviews after their first clinic appointment, and after they were accepted or found ineligible for KT. AA (n=199) were younger, less educated, and less likely to be married than WH (n=271). AA were more likely to be on hemodialysis, and less likely to have a potential living donor than WH. They experienced significantly more healthcare discrimination, perceived more overall healthcare racism, had higher levels of medical mistrust, greater family loyalty, and more religious objections to KT than WH. Although AA had higher levels of self-esteem and mastery than did WH, they had lower levels of TK. AAs were more willing to accept a living donor volunteer and ask someone to be a living kidney donor. Few differences in QOL were found, with AA indicating better self-rated health than WH. Although we found no race disparities in the proportion accepted for transplant listing, AA took significantly longer to get accepted than did WH (all ps<.05). Age, having private insurance in addition to VA, TK, and preference for a living donor explained race disparities in time to acceptance independently of race. We found expected race differences on all predictor variables, and time to acceptance, but not in QOL or proportion accepted for KT, across all 4 VA KT centers in the US. Because the procedures for KT evaluation in the VA are markedly different than those in non-VA settings, we believe that healthcare system factors may have contributed to reduced disparities in outcomes.