Buford Jade, Retzloff Samantha, Wilk Adam S, McPherson Laura, Harding Jessica L, Pastan Stephen O, Patzer Rachel E
Regenstrief Institute, Indianapolis, Indiana.
HIV Surveillance Branch (HSB), Division of HIV Prevention (DHP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia.
Kidney Med. 2023 Aug 5;5(10):100706. doi: 10.1016/j.xkme.2023.100706. eCollection 2023 Oct.
RATIONALE & OBJECTIVE: Patients with kidney failure from racial and ethnic minority groups and older patients have reduced access to the transplant waitlist relative to White and younger patients. Although racial disparities in the waitlisting group have declined after the 2014 kidney allocation system change, whether there is intersectionality of race and age in waitlisting access is unknown.
Retrospective cohort study.
SETTING & PARTICIPANTS: 439,455 non-Hispanic White and non-Hispanic Black US adults initiating dialysis between 2015 and 2019 were identified from the United States Renal Data System, and followed through 2020.
Patient race and ethnicity (non-Hispanic White and non-Hispanic Black) and age group (18-29, 30-49, 50-64, and 65-80 years).
Placement on the United Network for Organ Sharing deceased donor waitlist.
Age- and race-stratified waitlisting rates were compared. Multivariable Cox proportional hazards models, censored for death, examined the association between race and waitlisting, and included interaction term for race and age.
Over a median follow-up period of 1 year, the proportion of non-Hispanic White and non-Hispanic Black patients waitlisted was 20.7% and 20.5%, respectively. In multivariable models, non-Hispanic Black patients were 14% less likely to be waitlisted (aHR, 0.86, 95% CI, 0.77-0.95). Relative differences between non-Hispanic Black and non-Hispanic White patients were different by age group. Non-Hispanic Black patients were 27%, 12%, and 20% less likely to be waitlisted than non-Hispanic White patients for ages 18-29 years (aHR, 0.73; 95% CI, 0.61-0.86), 50-64 (aHR, 0.88; 95% CI, 0.80-0.98), and 65-80 years (aHR, 0.80; 95% CI, 0.71-0.90), respectively, but differences were attenuated among patients aged 30-49 years (aHR, 0.89; 95% CI, 0.77-1.02).
Race and ethnicity data is physician reported, residual confounding, and analysis is limited to non-Hispanic White and non-Hispanic Black patients.
Racial disparities in waitlisting exist between non-Hispanic Black and non-Hispanic White individuals and are most pronounced among younger patients with kidney failure. Results suggest that interventions to address inequalities in waitlisting may need to be targeted to younger patients with kidney failure.
PLAIN-LANGUAGE SUMMARY: Research has shown that patients from racial and ethnic minority groups and older patients have reduced access to transplant waitlisting relative to White and younger patients; nevertheless, how age impacts racial disparities in waitlisting is unknown. We compared waitlisting between non-Hispanic Black and non-Hispanic White patients with incident kidney failure, within age strata, using registry data for 439,455 US adults starting dialysis (18-80 years) during 2015-2019. Overall, non-Hispanic Black patients were less likely to be waitlisted and relative differences between the two racial groups differed by age. After adjusting for patient-level factors, the largest disparity in waitlisting was observed among adults aged 18-29 years. These results suggest that interventions should target younger adults to reduce disparities in access to kidney transplant waitlisting.
与白人和年轻患者相比，来自少数种族和族裔群体的肾衰竭患者以及老年患者进入移植等待名单的机会减少。尽管在2014年肾脏分配系统改变后，等待名单组中的种族差异有所下降，但在等待名单获取方面种族和年龄是否存在交叉性尚不清楚。
回顾性队列研究。
从美国肾脏数据系统中识别出2015年至2019年间开始透析的439,455名非西班牙裔白人及非西班牙裔黑人美国成年人，并随访至2020年。
患者的种族和族裔（非西班牙裔白人及非西班牙裔黑人）以及年龄组（18 - 29岁、30 - 49岁、50 - 64岁和65 - 80岁）。
被列入器官共享联合网络已故捐赠者等待名单。
比较按年龄和种族分层的等待名单率。多变量Cox比例风险模型，对死亡进行截尾处理，研究种族与等待名单之间的关联，并纳入种族和年龄的交互项。
在中位随访期1年期间，被列入等待名单的非西班牙裔白人及非西班牙裔黑人患者比例分别为20.7%和20.5%。在多变量模型中，非西班牙裔黑人患者被列入等待名单的可能性低14%（调整后风险比，0.86；95%置信区间，0.77 - 0.95）。非西班牙裔黑人与非西班牙裔白人患者之间的相对差异因年龄组而异。18 - 29岁的非西班牙裔黑人患者被列入等待名单的可能性比非西班牙裔白人患者低27%（调整后风险比，0.73；95%置信区间，0.61 - 0.86），50 - 64岁的低12%（调整后风险比，0.88；95%置信区间，0.80 - 0.98），65 - 80岁的低20%（调整后风险比，0.80；95%置信区间，0.71 - 0.90），但在30 - 49岁的患者中差异减弱（调整后风险比，0.89；95%置信区间，0.77 - 1.02）。
种族和族裔数据由医生报告，存在残余混杂因素，且分析仅限于非西班牙裔白人和非西班牙裔黑人患者。
非西班牙裔黑人和非西班牙裔白人个体在等待名单方面存在种族差异，且在年轻的肾衰竭患者中最为明显。结果表明，解决等待名单不平等问题的干预措施可能需要针对年轻的肾衰竭患者。
研究表明，与白人和年轻患者相比，少数种族和族裔群体的患者以及老年患者进入移植等待名单的机会减少；然而，年龄如何影响等待名单中的种族差异尚不清楚。我们使用2015 - 2019年间开始透析（18 - 80岁）的439,455名美国成年人的登记数据，比较了年龄层内非西班牙裔黑人和非西班牙裔白人新发肾衰竭患者的等待名单情况。总体而言，非西班牙裔黑人患者被列入等待名单的可能性较小，且两个种族群体之间的相对差异因年龄而异。在调整患者层面因素后，18 - 29岁成年人中观察到的等待名单差异最大。这些结果表明，干预措施应针对年轻成年人，以减少肾脏移植等待名单获取方面的差异。
