Relationship Between Zip Code Racial Composition and Kidney Transplantation Practices.

Abstract

Background: A disproportionately large number of black US dialysis patients live in zip codes where most other residents are black. Little is known about practices and outcomes after kidney transplant in patients living in these predominantly black residential areas. Methods: Using data from the United States Renal Data System (USRDS), we identified 69,319 patients who were either black or white and received their first kidney transplant between 1/1/2000 and 9/30/2005. We compared recipient, donor and procedure characteristics and patient and graft survival after transplant among patients living in predominantly black ( ≥50% black residents) vs. other (<50% black residents) zip codes. Results: Forty-one percent of black (n=7,257) and 2% of white (n=972) cohort members lived in a predominantly black zip code (n=938, 5.6% of zip codes). Blacks had a lower rate of living donors compared to whites (26% vs. 45%). Adjusted analyses (table) demonstrated that recipients living in predominantly black vs. other zip codes had a 15% higher risk of receiving deceased donor transplant, 21% higher rate of being on HD vs. PD prior to transplant, 13% higher chance of being on dialysis for 2 years prior to transplant, 20% lower chance of receiving a zero mismatch kidney and 19% receiving a preemptive transplant. Adjusted association racial composition on kidney transplant characteristics.Table: No Caption available.*Relative risk for patients living in zip codes with ≥50% vs. <50% black residents (95% confidence interval) ** gender of recipient, age at transplant, donor type, dialysis modality pretx, time on dialysis, premptive tx vs.not, donor race, donor BMI, recipient comorbidities including BMI, presence of diabetes, CVD and cause of ESRD, education, employement, transplant center effect. Conclusions: Blacks segregate to black neighborhoods. Living in predominantly black neighborhoods has an adverse impact on treatment practices related to kidney transplant.