Original Articles
Racial Disparities in Pediatric Access to Kidney Transplantation: Does Socioeconomic Status Play a Role?

https://doi.org/10.1111/j.1600-6143.2011.03888.xGet rights and content
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Racial disparities persist in access to renal transplantation in the United States, but the degree to which patient and neighborhood socioeconomic status (SES) impacts racial disparities in deceased donor renal transplantation access has not been examined in the pediatric and adolescent end-stage renal disease (ESRD) population. We examined the interplay of race and SES in a population-based cohort of all incident pediatric ESRD patients <21 years from the United States Renal Data System from 2000 to 2008, followed through September 2009. Of 8 452 patients included, 30.8% were black, 27.6% white-Hispanic, 44.3% female and 28.0% lived in poor neighborhoods. A total of 63.4% of the study population was placed on the waiting list and 32.5% received a deceased donor transplant. Racial disparities persisted in transplant even after adjustment for SES, where minorities were less likely to receive a transplant compared to whites, and this disparity was more pronounced among patients 18–20 years. Disparities in access to the waiting list were mitigated in Hispanic patients with private health insurance. Our study suggests that racial disparities in transplant access worsen as pediatric patients transition into young adulthood, and that SES does not explain all of the racial differences in access to kidney transplantation.

Key words:

Access to transplantation
health insurance
kidney transplant waiting list
neighborhood poverty
pediatric kidney transplantation
racial and ethnic disparities
United States Renal Data System

Abbreviations:

BMI
body mass index
CI
confidence interval
CMS
Centers for Medicare and Medicaid Services
ESA
erythropoiesis-stimulating agent
ESRD
end-stage renal disease
FSGS
focal segmental glomerulosclerosis
GN
glomerulonephritis
HR
hazard ratio
IQR
interquartile range
PPRA
peak panel reactive antibody
SES
socioeconomic status
UNOS
United Network for Organ Sharing
USRDS
United States Renal Data System

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