Consistency of Racial Variation in Medical Outcomes Among Publicly and Privately Insured Living Kidney Donors (original) (raw)
Related papers
Racial Variation in Medical Outcomes among Living Kidney Donors
New England Journal of Medicine, 2010
Background Data regarding health outcomes among living kidney donors are lacking, especially among nonwhite persons. Methods We linked identifiers from the Organ Procurement and Transplantation Network (OPTN) with administrative data of a private U.S. health insurer and performed a retrospective study of 4650 persons who had been living kidney donors from October 1987 through July 2007 and who had post-donation nephrectomy benefits with this insurer at some point from 2000 through 2007. We ascertained post-nephrectomy medical diagnoses and conditions requiring medical treatment from billing claims. Cox regression analyses with left and right censoring to account for observed periods of insurance benefits were used to estimate absolute prevalence and prevalence ratios for diagnoses after nephrectomy. We then compared prevalence patterns with those in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) for the general population. Results Among the donors, 76.3% were white, 13.1% black, 8.2% Hispanic, and 2.4% another race or ethnic group. The median time from donation to the end of insurance benefits was 7.7 years. After kidney donation, black donors, as compared with white donors, had an increased risk of hypertension (adjusted hazard ratio, 1.52; 95% confidence interval [CI], 1.23 to 1.88), diabetes mellitus requiring drug therapy (adjusted hazard ratio, 2.31; 95% CI, 1.33 to 3.98), and chronic kidney disease (adjusted hazard ratio, 2.32; 95% CI, 1.48 to 3.62); findings were similar for Hispanic donors. The absolute prevalence of diabetes among all donors did not exceed that in the general population, but the prevalence of hypertension exceeded NHANES estimates in some subgroups. End-stage renal disease was identified in less than 1% of donors but was more common among black donors than among white donors. Conclusions As in the general U.S. population, racial disparities in medical conditions occur among living kidney donors. Increased attention to health outcomes among demographically diverse kidney donors is needed.
Race, Relationship and Renal Diagnoses After Living Kidney Donation
Transplantation, 2015
In response to recent studies, a better understanding of the risks of renal complications among African American and biologically related living kidney donors is needed. We examined a database linking U.S. registry identifiers for living kidney donors (1987-2007) to billing claims from a private health insurer (2000-2007 claims) to identify renal condition diagnoses categorized by International Classification of Diseases 9th Revision coding. Cox regression with left and right censoring was used to estimate cumulative incidence of diagnoses after donation and associations (adjusted hazards ratios, aHR) with donor traits. Among 4650 living donors, 13.1% were African American and 76.3% were white; 76.1% were first-degree relatives of their recipient. By 7 years post-donation, after adjustment for age and sex, greater proportions of African American compared with white donors had renal condition diagnoses: chronic kidney disease (12.6% vs 5.6%; aHR, 2.32; 95% confidence interval [95% CI...
Transplantation Proceedings, 2009
Previous multivariate analysis performed between April 1, 1994, and December 31, 2000 from the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database has shown that kidneys from black donors were associated with lower graft survival. We compared graft and patient survival of different kidney donor-to-recipient ethnic combinations to see if this result still holds on a recent cohort of US kidney transplants.We included 72,495 recipients of deceased and living donor kidney alone transplants from 2001 to 2005. A multivariate Cox regression method was used to analyze the effect of donor–recipient ethnicity on graft and patient survival within 5 years of transplant, and to adjust for the effect of other donor, recipient, and transplant characteristics. Results are presented as hazard ratios (HR) with the 95% confidence limit (CL) and P values.Adjusted HRs of donor–recipient patient survival were: white to white (1); and white to black (1.22; P = .001). Graft survival HRs were black to black (1.40; P <.001); black to white (1.35; P <.001); black to Hispanic (0.87; P = .18); and black to Asian (0.69; P =.05).Black donor kidneys are associated with significantly lower graft survival when transplanted into whites or blacks and are only associated with lower patient survival when these kidneys are transplanted into white recipients. The graft and patient survival rates for Asian and Latino/Hispanic recipients, however, were not affected by donor ethnicity. This analysis underscores the need for research to better understand the reasons for these disparities and how to improve the posttransplant graft survival rates of black kidney recipients.
Clinical Transplantation, 2011
Kidney transplantation is the renal replacement therapy of choice for end-stage renal disease (ESRD). Over the last 20 yr, the number of waitlisted candidates has increased substantially, with a relatively small increase in the deceased donor pool (1). As a result, there has been increasing need for living kidney donors. Access to living kidney donors has varied among ethnic groups in part because of differences in waitlist representation. African Americans (AA) are overrepresented in the ESRD and kidney transplant waitlist populations (29% and 34%, respectively) (1, 2), relative to their percentage within the US population (13%) (3). However, over 70% of deceased kidney donors are Caucasian (CA). Differences in the distribution of human leukocyte antigens (HLA), antibody sensitization and ABO blood types, these demographic differences often lead to prolonged deceased donor waiting times for AA as opposed to other ethnic groups (1). Despite the growing need, there is a disproportionately lower rate of live kidney donation among AA (1). Previous literature has focused primarily on ethnic differences in living donor willingness, trust in the health care system and completion of donor evaluations as reasons for the lower rates of live kidney donation in AA (4-9). Little attention has been paid to the possibility that medical Norman SP, Song PXK, Hu Y, Ojo AO. Transition from donor candidates to live kidney donors: the impact of race and undiagnosed medical disease states.
Transplantation, 2008
Background-Previous multivariate analysis during 4/1/94-12/31/00 from the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database has shown that kidneys from Black donors were associated with lower graft survival. We compared graft and patient survival of different kidney donor-to-recipient ethnic combinations to see if this result still holds on a recent cohort of US kidney transplants. Methods-72,495 recipients of deceased and living donor kidney alone transplants from 2001-2005 were included. A multivariate Cox regression method was used to analyze the effect of donorrecipient ethnicity on graft and patient survival within 5 years of transplant, and to adjust for the effect of other donor, recipient and transplant characteristics. Results are presented as hazard ratios (HR) with the 95% confidence limit (CL) and p-values. Results-Adjusted HR's of donor-recipient patient survival: White to White (1), White to Black (1.22, p=.001). Graft survival HRS: Black to Black (1.40, p<0.001), Black to White (1.35, p<0.001), Black to Hispanic (0.87, p=0.18), Black to Asian (0.69, p=0.05). Summary-Black donor Kidneys are associated with significantly lower graft survival when transplanted into Whites and Blacks and are only associated with lower patient survival when these kidneys are transplanted into White transplant recipients. The graft and patient survival rates for Asian and Latino/Hispanic recipients however were not affected by donor ethnicity. This analysis underscores the need for research to better understand the reasons for these disparities and how to improve the post transplant graft survival rates of Blacks.
Racial Disparities in Kidney Graft Survival: Does Donor Quality Explain the Difference?
American Journal of Transplantation, 2012
Racial disparities exist in access to kidney transplantation. Despite a threefold higher rate of end stage renal disease among African Americans (AA) compared to Caucasians (1), AAs face significant barriers in access to transplant referral, waitlisting and transplantation (2). Challenges continue for AAs even after organ receipt. As highlighted in the 2010 SRTR data report, 5-year graft survival for deceased donor (DD) transplants was 74.8% (± 0.4%) for Caucasians and 66.3% (±0.5%) for AAs and these differences increase over time (1). The reasons for the disparities are unclear, and are likely multifactorial.
Journal of the …, 2008
Although the majority of deceased-donor kidneys are donated after brain death, increased recovery of kidneys donated after cardiac death could reduce the organ shortage and is now a national priority. Racial disparities in donations after brain death have been well described for renal transplantation, but it is unknown whether similar disparities occur in donations after cardiac death. In this study, outcomes of adult deceaseddonor renal transplant recipients included in the United Network for Organ Sharing database (1993 through 2006) were analyzed. Among black recipients of kidneys obtained after cardiac death, those who received kidneys from black donors had better long-term graft and patient survival than those who received kidneys from white donors. In addition, compared with standard-criteria kidneys from white donors after brain death, kidneys from black donors after cardiac death conferred a 70% reduction in the risk for graft loss (adjusted hazard ratio 0.30; 95% confidence interval 0.14 to 0.65; P ϭ 0.002) and a 59% reduction in risk for death (adjusted hazard ratio 0.41; 95% confidence interval 0.2 to 0.87; P ϭ 0.02) among black recipients. These findings suggest that kidneys obtained from black donors after cardiac death may afford the best long-term survival for black recipients.
BMJ Open, 2017
Objectives Inferior outcomes for black kidney transplant recipients in the USA may not be generalisable elsewhere. In this population cohort analysis, we compared outcomes for black kidney transplant patients in England versus New York State. Design Retrospective, comparative, population cohort study utilising administrative data registries. Settings and participants English data were derived from Hospital Episode Statistics, while New York State data were derived from Statewide Planning and Research Cooperative System. All adults receiving their first kidney-alone allograft between 2003 and 2013 were eligible for inclusion. Measures The primary outcome measure was mortality post kidney transplantation (including inhospital death, 30-day mortality and 1-year mortality). Secondary outcome measures included postoperative admission length of stay, risk of rehospitalisation, development of cardiac events, stroke, cancer or fracture and finally transplant rejection/failure. Cox proportional hazards regression was used to investigate relationship between ethnicity, country and outcome. Results Black patients comprised 6.5% of the English cohort (n=1215/18 493) and 23.0% of the New York State cohort (n=2660/11 602). Compared with New York State, black kidney transplant recipients in England were more likely younger, male, living-donor kidney recipients and had dissimilar medical comorbidities. Inpatient mortality was not statistically different, but death within 30 days, 1 year or kidney transplant rejection/failure was lower among black patients in England versus black patients in New York State. In adjusted regression analysis, with black ethnicity the reference group, white patients had reduced risk for 30day mortality (OR 0.62 (95% CI 0.44 to 0.86)) and 1-year mortality (OR 0.79 (95% CI 0.63 to 0.99)) in New York State but no difference was observed in England. Compared with England, black kidney transplant patients in New York State had increased HR for kidney transplant rejection rejection/ failure by median follow-up (HR 2.15, 95% CI 1.91 to 2.43). Conclusions Outcomes after kidney transplantation for black patients may not be translatable between countries.
American Journal of Transplantation, 2010
Coincident with an increasing national interest in equitable health care, a number of studies have described disparities in access to solid organ transplantation for minority patients. In contrast, relatively little is known about differences in posttransplant outcomes between patients of specific racial and ethnic populations. In this paper, we review trends in access to solid organ transplantation and posttransplant outcomes by organ type, race and ethnicity. In addition, we present an analysis of categories of factors that contribute to the racial/ethnic variation seen in kidney transplant outcomes. Disparities in minority access to transplantation among wait-listed candidates are improving, but persist for those awaiting kidney, simultaneous kidney and pancreas and intestine transplantation. In general, graft and patient survival among recipients of solid organ transplants is highest for Asians and Hispanic/Latinos, intermediate for whites and lowest for African Americans. Although much of the difference in outcomes between racial/ethnic groups can be accounted for by adjusting for patient characteristics, important observed differences remain. Age and duration of pretransplant dialysis exposure emerge as the most important determinants of survival in an investigation of the relative impact of center-related versus patientrelated variables on kidney graft outcomes.
An Assurance of Insurance: Should Living Kidney Donors be Required to have Health Insurance?
Diversity & Equality in Health and Care
Background: The aims of the study were to examine if living donors followed the recommended UNOS medical visits postsurgery examinations and to assess if medical outcomes after donating a kidney were different by insurance status. Methods: Data was collected from the medical records of 680 consecutive living kidney donors between January 2010 and June 2015. Results: Significant predictors of having health insurance included higher levels of education (p=0.007) and being married (p=0.031). Post-surgical visits were lower for those without insurance at six months (43% versus 77%; p=0.029) and one year (35% versus 77%, p<0.001) than those with insurance. A robust trend was observed whereas lack of health insurance was predictive of higher systolic blood pressure (p=0.05). Significant predictors of higher systolic blood pressure included being older (p<0.001), male (p<0.001); and non-Caucasian (p=0.012). Significant predictors of higher diastolic blood pressure were being male (p<0.001) and non-Caucasian (p=0.020); and prior drug use (p=0.003). Conclusion: Development of interventions to improve postsurgical follow up for kidney donors without insurance is warranted to potentially reduce poor health outcomes such as hypertension post kidney donation.