Emory Transplant Center, Emory University, Atlanta, GA, USA.
Am J Transplant. 2012 Feb;12(2):358-68. doi: 10.1111/j.1600-6143.2011.03927.x. Epub 2012 Jan 10.
Racial disparities in access to renal transplantation exist, but the effects of race and socioeconomic status (SES) on early steps of renal transplantation have not been well explored. Adult patients referred for renal transplant evaluation at a single transplant center in the Southeastern United States from 2005 to 2007, followed through May 2010, were examined. Demographic and clinical data were obtained from patient's medical records and then linked with United States Renal Data System and American Community Survey Census data. Cox models examined the effect of race on referral, evaluation, waitlisting and organ receipt. Of 2291 patients, 64.9% were black, the mean age was 49.4 years and 33.6% lived in poor neighborhoods. Racial disparities were observed in access to referral, transplant evaluation, waitlisting and organ receipt. SES explained almost one-third of the lower rate of transplant among black versus white patients, but even after adjustment for demographic, clinical and SES factors, blacks had a 59% lower rate of transplant than whites (hazard ratio = 0.41; 95% confidence interval: 0.28-0.58). Results suggest that improving access to healthcare may reduce some, but not all, of the racial disparities in access to kidney transplantation.
种族差异确实存在于接受肾移植的机会中，但种族和社会经济地位（SES）对肾移植早期阶段的影响尚未得到充分探讨。本研究对 2005 年至 2007 年在美国东南部的一家移植中心接受肾移植评估的成年患者进行了研究，随访至 2010 年 5 月。研究人员从患者的病历中获取了人口统计学和临床数据，然后将这些数据与美国肾脏数据系统和美国社区调查普查数据进行了关联。Cox 模型分析了种族对转诊、评估、等候名单和器官接受的影响。在 2291 名患者中，64.9%是黑人，平均年龄为 49.4 岁，33.6%生活在贫困社区。在获得转诊、移植评估、等候名单和器官接受方面存在种族差异。SES 解释了黑人患者接受移植的比率低于白人患者的近三分之一，但即使在调整了人口统计学、临床和 SES 因素后，黑人患者的移植率仍比白人患者低 59%（风险比=0.41；95%置信区间：0.28-0.58）。研究结果表明，改善医疗保健的可及性可能会减少一些，但不是全部，种族差异在获得肾移植方面的影响。
