Racial Disparities in Sexual Health Care Received by Kidney Transplant Recipients in a Metropolitan Area

Abstract

ABSTRACT Introduction Issues regarding disparities in urologic health care delivery and access among different racial and ethnic groups in the United States is well described in oncologic care. Such issues also exist in male sexual health care and kidney transplantation, but are less studied when these areas overlap. As a result of improved outcomes with kidney transplants (KT), quality of life (QOL) metrics become increasingly important to address. Sexual function is one such QOL domain in which KT recipients are particularly affected. Objective This study aims to elucidate the racial composition of male KT recipients with and without a sexual health issue, how that compares to the racial breakdown of the metropolitan area, and whether a particular racial group is more likely to be diagnosed with sexual dysfunction before versus after their transplant surgery. Methods After obtaining IRB approval we retrospectively reviewed the charts of men age 18 and older who received a KT at a single institution in a metropolitan city between January 2016 and February 2020. We sought to identify those with a diagnosis of ED, low or decreased libido, hypogonadism, ejaculatory dysfunction, Peyronie's disease (PD), or male factor subfertility. Demographic information, time of initial diagnosis of ED, and treatment profile were documented. The causes of end stage renal disease (ESRD) were obtained, but not controlled for. Results A total of 833 men received KT's during this time, 43% of which identified as Hispanic or Latino, 26% white (non-Hispanic or Latino), 13% Asian, and 12% Black. Of the men with a sexual dysfunction diagnosis, 26% identified as Hispanic or Latino, 31% white (non-Hispanic or Latino), 14% Asian, and 23% Black (Figure 1). No men were found to have a diagnosis of ejaculatory dysfunction, PD, or male factor subfertility. Latino men were more likely to have a diagnosis of sexual dysfunction after receiving a KT when compared to their non-Latino counterparts (OR: 2.91, 95% CI: [0.41 to 20.90]). Finally, there was no statistically significant difference in treatment patterns for ED between racial groups. Conclusions In this study we show that the overall racial composition of men age 18 and over who received a KT is representative of the demographics in its corresponding metropolitan city. However, we do note that Latino men are underdiagnosed for sexual dysfunction issues when compared to their non-Latino counterparts. Latino men are also more likely to have a diagnosis of sexual dysfunction after their transplant, likely implying they suffer from these conditions longer than men of other races. These findings highlight the need for continued research to reduce and eliminate health care disparities in the sexual health arena, specifically for patients with ESRD. Disclosure No