Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States of America.
Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States of America.
Transplant Rev (Orlando). 2023 Apr;37(2):100751. doi: 10.1016/j.trre.2023.100751. Epub 2023 Mar 11.
The kidney is the most needed organ for transplantation in the United States. However, demand and scarcity of this organ has caused significant inequities for historically marginalized groups. In this review, we report on the frequency of inequities in all steps of kidney transplantation from 2016 to 2022. Search criteria was based on the National Institute of Health's (NIH) 2022 list of populations who experience health inequities, which includes: race and ethnicity; sex or gender; Lesbian, Gay, Bisexual, Transgender, Queer + (LGBTQ+); underserved rural communities; education level; income; and occupation status. We outline steps for future research aimed at assessing interventions and programs to improve health outcomes.
This scoping review was developed following guidelines from the Joanna Briggs Institute and PRISMA extension for scoping reviews. In July 2022, we searched Medline (via PubMed) and Ovid Embase databases to identify articles addressing inequities in access to kidney transplantation in the United States. Articles had to address at least one of the NIH's 2022 health inequity groups.
Our sample of 44 studies indicate that Black race, female sex or gender, and low socioeconomic status are negatively associated with referral, evaluation, and waitlisting for kidney transplantation. Furthermore, only two studies from our sample investigated LGBTQ+ identity since the NIH's addition of SGM in 2016 regarding access to transplantation. Lastly, we found no detectable trend in studies for the four most investigated inequity groups between 2016 and 2022.
Investigations in inequities for access to kidney transplantation for the two most studied groups, race/ethnicity and sex or gender, have shown no change in frequencies. Regarding race and ethnicity, continued interventions focused on educating Black patients and staff of dialysis facilities may increase transplant rates. Studies aimed at assessing effectiveness of the Kidney Paired Donation program are highly warranted due to incompatibility problems in female patients. The sparse representation for the LGBTQ+ population may be due to a lack of standardized data collection for sexual orientation. We recommend this community be engaged via surveys and further investigations.
在美国，肾脏是最需要进行移植的器官。然而，这种器官的需求和短缺导致历史上被边缘化的群体面临着严重的不平等。在本综述中，我们报告了 2016 年至 2022 年期间，肾脏移植所有阶段的不平等现象的发生频率。检索标准基于美国国立卫生研究院（NIH）2022 年列出的经历健康不平等的人群，包括：种族和民族；性别；女同性恋、男同性恋、双性恋、跨性别、酷儿+（LGBTQ+）；服务不足的农村社区；教育水平；收入；和职业地位。我们概述了未来旨在评估干预措施和方案以改善健康结果的研究步骤。
本范围综述是根据 Joanna Briggs 研究所和 PRISMA 扩展用于范围综述的指南制定的。2022 年 7 月，我们检索了 Medline（通过 PubMed）和 Ovid Embase 数据库，以确定在美国解决肾脏移植机会不平等问题的文章。文章必须至少涉及 NIH 2022 年健康不平等群体中的一个。
我们的 44 项研究样本表明，黑人种族、女性性别或性别以及低社会经济地位与肾脏移植的转诊、评估和等候名单呈负相关。此外，由于 NIH 自 2016 年以来将 SGM 纳入 LGBTQ+身份，我们的样本中只有两项研究调查了 LGBTQ+身份与移植机会的关系。最后，我们没有发现 2016 年至 2022 年期间，在对这四个最受调查的不平等群体进行的研究中存在任何可检测的趋势。
对种族和民族以及性别或性别这两个研究最多的群体获得肾脏移植机会的不平等调查显示，其频率没有变化。关于种族，继续对黑人患者和透析设施工作人员进行教育的干预措施可能会提高移植率。由于女性患者在肾脏配对捐赠计划中存在不兼容问题，因此非常需要评估该计划效果的研究。LGBTQ+群体的代表性稀缺可能是由于缺乏标准化的性取向数据收集所致。我们建议通过调查和进一步研究让该群体参与进来。
