Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Department of Internal Medicine, Center for Healthcare Equity in Kidney Disease, University of New Mexico School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM.
Transplantation. 2022 Apr 1;106(4):e219-e233. doi: 10.1097/TP.0000000000004054.
Racial/ethnic minorities face known disparities in likelihood of kidney transplantation. These disparities may be exacerbated when coupled with ongoing substance use, a factor also reducing likelihood of transplantation. We examined whether race/ethnicity in combination with ongoing substance use predicted incidence of transplantation.
Patients were enrolled between March 2010 and October 2012 at the time of transplant evaluation. Substance use data were retrieved from transplant evaluations. Following descriptive analyses, the primary multivariable analyses evaluated whether, relative to the referent group (White patients with no substance use), racial/ethnic minority patients using any substances at the time of evaluation were less likely to receive transplants by the end of study follow-up (August 2020).
Among 1152 patients, 69% were non-Hispanic White, 23% non-Hispanic Black, and 8% Other racial/ethnic minorities. White, Black, and Other patients differed in percentages of current tobacco smoking (15%, 26%, and 18%, respectively; P = 0.002) and illicit substance use (3%, 8%, and 9%; P < 0.001) but not heavy alcohol consumption (2%, 4%, and 1%; P = 0.346). Black and Other minority patients using substances were each less likely to receive transplants than the referent group (hazard ratios ≤0.45, P ≤ 0.021). Neither White patients using substances nor racial/ethnic minority nonusers differed from the referent group in transplant rates. Additional analyses indicated that these effects reflected differences in waitlisting rates; once waitlisted, study groups did not differ in transplant rates.
The combination of minority race/ethnicity and substance use may lead to unique disparities in likelihood of transplantation. To facilitate equity, strategies should be considered to remove any barriers to referral for and receipt of substance use care in racial/ethnic minorities.
少数族裔在接受肾移植的可能性方面面临已知的差异。当这种差异与持续的物质使用相结合时，可能会加剧这种差异，而物质使用也是降低移植可能性的一个因素。我们研究了种族/民族与持续的物质使用相结合是否会预测移植的发生。
患者于 2010 年 3 月至 2012 年 10 月在接受移植评估时入组。物质使用数据是从移植评估中检索到的。在描述性分析之后，主要的多变量分析评估了与参照组（无物质使用的白人患者）相比，评估时使用任何物质的少数族裔患者在研究随访结束（2020 年 8 月）时接受移植的可能性是否更低。
在 1152 名患者中，69%是非西班牙裔白人，23%是非西班牙裔黑人，8%是其他少数族裔。白人、黑人及其他种族的患者在当前吸烟（分别为 15%、26%和 18%；P=0.002）和非法物质使用（分别为 3%、8%和 9%；P<0.001）的百分比上存在差异，但在大量饮酒（分别为 2%、4%和 1%；P=0.346）方面没有差异。使用物质的黑人及其他少数族裔患者接受移植的可能性均低于参照组（风险比≤0.45，P≤0.021）。使用物质的白人患者或非使用物质的少数族裔患者与参照组在移植率上没有差异。进一步的分析表明，这些影响反映了候补名单率的差异；一旦列入候补名单，研究组在移植率上没有差异。
少数族裔种族/民族和物质使用的结合可能导致接受移植的可能性存在独特的差异。为了促进公平，应考虑采取策略，消除少数族裔在寻求和接受物质使用治疗方面的任何障碍。
