Modifiable patient characteristics and racial disparities in evaluation completion and living donor transplant

Amy D. Waterman, John D. Peipert, Shelley S. Hyland, Melanie S. Mccabe, Emily A. Schenk, Jingxia Liu

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background and objectives To reduce racial disparities in transplant, modifiable patient characteristics associated with completion of transplant evaluation and receipt of living donor kidney transplant must be identified. Design, setting, participants, & measurements From 2004 to 2007, 695 black and white patients were surveyed about 15 less-modifiable and 10more-modifiable characteristics at evaluation onset;whether they had completed evaluation within 1 year and received living donor kidney transplants by 2010 was determined. Logistic regression and competing risks time-to-event analysis were conducted to determine the variables that predicted evaluation completion and living donor kidney transplant receipt. Results Not adjusting for covariates, blacks were less likely than whites to complete evaluation (26.2% versus 51.8%, P<0.001) and receive living donor kidney transplants (8.7% versus 21.9%, P<0.001). More-modifiable variables associated with completing evaluation included more willing to be on the waiting list (odds ratio=3.4, 95% confidence interval=2.1, 5.7), more willing to pursue living donor kidney transplant (odds ratio=2.7, 95% confidence interval=1.8, 4.0), having access to more transplant education resources (odds ratio=2.2, 95% confidence interval=1.5, 3.2), and having greater transplant knowledge (odds ratio=1.8, 95% confidence interval=1.2, 2.7). Patients who started evaluation more willing to pursue living donor kidney transplant (hazard ratio=4.3, 95% confidence interval=2.7, 6.8) and having greater transplant knowledge (hazard ratio=1.2, 95% confidence interval=1.1, 1.3) were more likely to receive living donor kidney transplants. Conclusions Because patients who began transplant evaluation with greater transplant knowledge and motivation were ultimately more successful at receiving transplants years later, behavioral and educational interventions may be very successful strategies to reduce or overcome racial disparities in transplant.

Original languageEnglish (US)
Pages (from-to)995-1002
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number6
DOIs
StatePublished - Jun 7 2013

Fingerprint

Living Donors
Transplants
Kidney
Confidence Intervals
Odds Ratio
Waiting Lists

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Waterman, Amy D. ; Peipert, John D. ; Hyland, Shelley S. ; Mccabe, Melanie S. ; Schenk, Emily A. ; Liu, Jingxia. / Modifiable patient characteristics and racial disparities in evaluation completion and living donor transplant. In: Clinical Journal of the American Society of Nephrology. 2013 ; Vol. 8, No. 6. pp. 995-1002.
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abstract = "Background and objectives To reduce racial disparities in transplant, modifiable patient characteristics associated with completion of transplant evaluation and receipt of living donor kidney transplant must be identified. Design, setting, participants, & measurements From 2004 to 2007, 695 black and white patients were surveyed about 15 less-modifiable and 10more-modifiable characteristics at evaluation onset;whether they had completed evaluation within 1 year and received living donor kidney transplants by 2010 was determined. Logistic regression and competing risks time-to-event analysis were conducted to determine the variables that predicted evaluation completion and living donor kidney transplant receipt. Results Not adjusting for covariates, blacks were less likely than whites to complete evaluation (26.2{\%} versus 51.8{\%}, P<0.001) and receive living donor kidney transplants (8.7{\%} versus 21.9{\%}, P<0.001). More-modifiable variables associated with completing evaluation included more willing to be on the waiting list (odds ratio=3.4, 95{\%} confidence interval=2.1, 5.7), more willing to pursue living donor kidney transplant (odds ratio=2.7, 95{\%} confidence interval=1.8, 4.0), having access to more transplant education resources (odds ratio=2.2, 95{\%} confidence interval=1.5, 3.2), and having greater transplant knowledge (odds ratio=1.8, 95{\%} confidence interval=1.2, 2.7). Patients who started evaluation more willing to pursue living donor kidney transplant (hazard ratio=4.3, 95{\%} confidence interval=2.7, 6.8) and having greater transplant knowledge (hazard ratio=1.2, 95{\%} confidence interval=1.1, 1.3) were more likely to receive living donor kidney transplants. Conclusions Because patients who began transplant evaluation with greater transplant knowledge and motivation were ultimately more successful at receiving transplants years later, behavioral and educational interventions may be very successful strategies to reduce or overcome racial disparities in transplant.",
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Modifiable patient characteristics and racial disparities in evaluation completion and living donor transplant. / Waterman, Amy D.; Peipert, John D.; Hyland, Shelley S.; Mccabe, Melanie S.; Schenk, Emily A.; Liu, Jingxia.

In: Clinical Journal of the American Society of Nephrology, Vol. 8, No. 6, 07.06.2013, p. 995-1002.

Research output: Contribution to journalArticle

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AU - Waterman, Amy D.

AU - Peipert, John D.

AU - Hyland, Shelley S.

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AU - Liu, Jingxia

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AB - Background and objectives To reduce racial disparities in transplant, modifiable patient characteristics associated with completion of transplant evaluation and receipt of living donor kidney transplant must be identified. Design, setting, participants, & measurements From 2004 to 2007, 695 black and white patients were surveyed about 15 less-modifiable and 10more-modifiable characteristics at evaluation onset;whether they had completed evaluation within 1 year and received living donor kidney transplants by 2010 was determined. Logistic regression and competing risks time-to-event analysis were conducted to determine the variables that predicted evaluation completion and living donor kidney transplant receipt. Results Not adjusting for covariates, blacks were less likely than whites to complete evaluation (26.2% versus 51.8%, P<0.001) and receive living donor kidney transplants (8.7% versus 21.9%, P<0.001). More-modifiable variables associated with completing evaluation included more willing to be on the waiting list (odds ratio=3.4, 95% confidence interval=2.1, 5.7), more willing to pursue living donor kidney transplant (odds ratio=2.7, 95% confidence interval=1.8, 4.0), having access to more transplant education resources (odds ratio=2.2, 95% confidence interval=1.5, 3.2), and having greater transplant knowledge (odds ratio=1.8, 95% confidence interval=1.2, 2.7). Patients who started evaluation more willing to pursue living donor kidney transplant (hazard ratio=4.3, 95% confidence interval=2.7, 6.8) and having greater transplant knowledge (hazard ratio=1.2, 95% confidence interval=1.1, 1.3) were more likely to receive living donor kidney transplants. Conclusions Because patients who began transplant evaluation with greater transplant knowledge and motivation were ultimately more successful at receiving transplants years later, behavioral and educational interventions may be very successful strategies to reduce or overcome racial disparities in transplant.

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