Age and Comorbidities Are Effect Modifiers of Gender Disparities in Renal Transplantation

Abstract

Women have less access to kidney transplantation than men, but the contributions of age and comorbidity to this disparity are largely unknown. We conducted a national cohort study of 563,197 patients with first-onset ESRD between 2000 and 2005. We used multivariate generalized linear models to evaluate both access to transplantation (ATT), defined as either registration for the deceased-donor waiting list or receiving a live-donor transplant, and survival benefit from transplantation, defined as the relative rate of survival after transplantation compared with the rate of survival on dialysis. We compared relative risks (RRs) between women and men, stratified by age categories and the presence of common comorbidities. Overall, women had 11% less ATT than men. When the model was stratified by age, 18-to 45-yr-old women had equivalent ATT to men (RR 1.01), but with increasing age, ATT for women declined dramatically, reaching a RR of 0.41 for those who were older than 75 yr, despite equivalent survival benefits from transplantation between men and women in all age subgroups. Furthermore, ATT for women with comorbidities was lower than that for men with the same comorbidities, again despite similar survival benefits from transplantation. This study suggests that there is no disparity in ATT for women in general but rather a marked disparity in ATT for older women and women with comorbidities. These disparities exist despite similar survival benefits from transplantation for men and women regardless of age or comorbidities.

Patient- and Provider-Reported Information about Transplantation and Subsequent Waitlisting

“…12 In addition, our finding that older adults (despite excluding those with dementia) were less likely to report receiving KTPI even when they were informed according to their provider is consistent with the documented age disparity in referral and access to KT. 5,[13][14][15][16] In other words, older age is consistently associated with lack of access in all steps in the process to KT from provision of information to transplantation. Finally, whereas other studies have shown that provider-reported KTPI is associated with listing, 5 our study suggests a novel mechanism in which patient perception of KTPI is actually what drives the association between KTPI and listing.…”

Barriers to Living Donor Kidney Transplantation among Black or Older Transplant Candidates

“…L iving donor kidney transplant (LDKT) is usually the best treatment option for kidney failure (1) but occurs less frequently among persons who are black or older (2)(3)(4). In 2007, blacks comprised only 13.8% of LDKT recipients in the United States-a percentage that has remained unchanged for 10 years (1).…”

“…LDKTs also occur less frequently among older patients (2-4), whose anticipated waiting time for a DDKT often exceeds their life expectancy (6). In addition, several studies have reported decreased access to LDKTs among women (4,(7)(8)(9), although other studies have found no gender differences (2,3).…”

Treatment biases in traumatic neurosurgical care: a retrospective study of the Nationwide Inpatient Sample from 1998 to 2009

“…One study reported that women have less access to transplant services. 17 At least 1 other failed to identify disparities in the likelihood of operative versus nonoperative management in relation to patient sex status. 1 Others have suggested better postsurgical outcomes for women following traumatic care, 13 although it is unclear whether this benefit extends to neurotrauma.…”