Freeman Michael A, Pleis John R, Bornemann Kellee R, Croswell Emilee, Dew Mary Amanda, Chang Chung-Chou H, Switzer Galen E, Langone Anthony, Mittal-Henkle Anuja, Saha Somnath, Ramkumar Mohan, Adams Flohr Jareen, Thomas Christie P, Myaskovsky Larissa
1 Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. 2 Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA. 3 Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 4 Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. 5 Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 6 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA. 7 Department of Psychology, University of Pittsburgh, Pittsburgh, PA. 8 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 9 Renal Section, Tennessee Valley VA Healthcare System, Nashville, TN. 10 Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 11 Kaiser Permanente, Northwest, Portland, OR. 12 Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, OR. 13 Department of Medicine, Oregon Health and Science University, Portland, OR. 14 Renal Section, Pittsburgh VA Healthcare System, Pittsburgh, PA. 15 Renal Section, Iowa City VA Healthcare System, Iowa City, IA. 16 Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
Transplantation. 2017 Jun;101(6):1191-1199. doi: 10.1097/TP.0000000000001377.
Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings.
We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors.
There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66-0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time.
Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.
少数群体在退伍军人事务部（VA）和非VA移植中心的肾移植（KT）中受到显著差异的影响。然而，先前VA的研究仅限于回顾性的二次数据库分析，这些分析同时关注KT过程的多个阶段。我们的目标是确定VA中KT评估期间是否存在如在非VA环境中发现的差异。
我们对4个国家VA KT中心的602例接受KT初始评估的患者进行了多中心纵向队列研究。参与者完成了一次电话访谈，以确定在控制医疗因素后，移植接受时间的差异是否可由患者的人口统计学、文化、心理社会或移植知识因素来解释。
KT接受时间上没有显著的种族差异[对数秩χ² = 1.04；P = 0.594]。年龄较小（风险比[HR]，0.98；95%置信区间[CI]，0.97 - 0.99）、合并症较少（HR，0.89；95% CI，0.84 - 0.95）、已婚（HR，0.81；95% CI，0.66 - 0.99）、拥有私人和公共保险（HR，1.29；95% CI，1.03 - 1.51）以及中度或更高水平的抑郁（HR，1.87；95% CI，1.03 - 3.29）预示着接受时间较短。KT类型（ deceased或活体供体）偏好和移植中心位置对接受天数的影响随时间变化。
我们的结果表明，VA国家移植系统在KT评估中没有表现出如在非VA移植中心发现的种族差异。
