"Editor's Pick" Article Examines Relationship between Perceived Racial Discrimination and Wait Times for Kidney Transplant
Although end-stage kidney disease (ESKD) in African Americans is four times greater than in whites, African Americans are less than one-half as likely to undergo kidney transplantation — the optimal treatment for ESKD. Evidence indicates that cultural factors including medical mistrust, perceived racism and discrimination, religious beliefs, and family influence play a key role in decision-making about medical interventions, and that these issues are critical to understanding disparities in kidney transplantation. This longitudinal cohort study sought to determine whether African American and white patients with ESKD undergoing evaluation for transplantation: 1) differ across cultural factors, transplant knowledge, and psychosocial characteristics; 2) differ in the rate of being accepted for kidney transplantation; and 3) whether potential differences in time to be accepted for transplant are explained by non-medical factors, after controlling for demographics and medical factors. Investigators identified 127 African American (n=33) and white patients (n=94) with ESKD that underwent evaluation for kidney transplantation between 12/06 and 7/07 at the University of Pittsburgh Starzl Transplant Institute or the VA Pittsburgh Healthcare System. Investigators conducted patient interviews and reviewed medical records to assess: demographics, medical factors (e.g., receipt of dialysis, comorbidities), cultural factors (e.g., patients' perceived discrimination, family influence), transplant knowledge, and psychosocial characteristics (e.g., anxiety and depression symptoms). The total number of days from first presenting to the transplant clinic until being accepted or found ineligible for transplant also was examined.
- Compared to whites, African Americans took significantly longer to get accepted for transplant.
- There were also significant racial differences on several cultural factors in patients as they began the evaluation process for kidney transplantation. Compared to white patients, African Americans reported experiencing more discrimination in healthcare, more perceptions of racism in healthcare, higher medical mistrust, and more religious objections to living donor kidney transplantation.
- Comorbidity, dialysis status, and availability of potential living donors were not associated with length of time to be accepted for kidney transplant. Thus, medical factors alone did not explain racial disparities.
- In analyses to identify which factors predicted racial disparities, the authors found that perceived discrimination in healthcare, less transplant knowledge, more religious objection to transplantation, and lower income explained the racial disparities observed in the time it took to be accepted for transplant. Moreover, after adjusting for demographics, psychosocial, and cultural factors, the association of race with longer time for listing for transplant was no longer significant.
- Authors suggest these findings indicate that perceived discrimination in healthcare can be as much of a risk factor as race, income, or low transplant knowledge.
- This study was conducted in only two healthcare facilities in one city.
- Investigators did not assess measures of patient adherence pre-transplant.
This study was partly funded by HSR&D (IIR 06-220). Dr. Myaskovsky is part of HSR&D's Center for Health Equity Research and Promotion, Pittsburgh, PA.
Myaskovsky L, Doebler D, Posluszny D, et al. Perceived Discrimination Predicts Longer Time to Be Accepted for Kidney Transplant. Transplantation, “Editor’s Pick.” February 27, 2012;93(4):423-429.