Geographic Variation in Access to Kidney Transplantation in the United States By Race.

Abstract

Background: Racial disparities exist in access to kidney transplantation in the United States (US), and kidney transplant rates are lowest in the Southeastern US compared to other regions. However, it is unknown whether racial disparities vary across geographic regions in the US. Methods: Among a cohort of 681,521 adult ESRD patients in the United States Renal Data System from 2005 through 2011, we examined black vs. white racial disparity in waitlisting and transplantation across geographic regions. We used Cox proportional hazards models to estimate crude hazard ratios (HRs) of waitlisting and transplantation by ESRD Network region. Results: On average, there are minor black vs. white racial disparities in access to waitlisting in the US (HR=0.98; 95% CI: 0.97-0.99). However, regional differences exist in racial disparities in access to waitlisting (interaction p<0.0001), with the Southeastern US having the worst racial disparity in access to waitlisting (HR=0.81; 95% CI: 0.77-0.84).Figure: No Caption available.Racial disparities exist in access to both deceased and living donor kidney transplantation in the US, where blacks have half the rate of transplantation vs. whites (HR=0.49; 95% CI: 0.48-0.50). Regional differences exist in racial disparities in access to kidney transplantation (interaction p <0.0002), and similar to waitlisting access, the Southeastern US has the worst racial disparity in access to kidney transplantation (HR=0.38; 95% CI: 0.35-0.40).Figure: No Caption available.Conclusion: We observed a large difference in racial disparity between access to waitlisting and transplantation, such that racial disparities were more pronounced after waitlisting. Further, disparities differed dramatically by US region, suggesting that it is essential to consider geographical differences when examining racial disparities in access to kidney transplantation.