High Rate of Living Kidney Donation to Immigrant Children Despite Disparities—An Epidemiological Paradox?

Öztek-Celebi, Fatma Zehra; Herle, Marion; Ritschl, Valentin; Kaltenegger, Lukas; Stamm, Tanja; Aufricht, Christoph; Böehm, Michael

doi:10.3389/fped.2019.00025

Cited by 7 publications

(12 citation statements)

References 29 publications

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“…Three studies examined areas otherwise not represented: immigration status and marital status. There were no differences in time on waitlist and rate of transplantation across immigration status in Austria 67,68 . However, the proportion of living donor transplants was higher among immigrant families 68 .…”

Section: Resultsmentioning

confidence: 82%

“…There were no differences in time on waitlist and rate of transplantation across immigration status in Austria 67,68 . However, the proportion of living donor transplants was higher among immigrant families 68 . In the US, single parents were less likely to know information related to transplant evaluation, cost, and insurance coverage, and more likely to believe outcomes were worse following living donation when compared to dual‐caregiver households 48 …”

Section: Resultsmentioning

confidence: 99%

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A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

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Background: Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre-and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods. Methods: Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases. Results: Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent. Conclusion: This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities. K E Y W O R D S social determinants of health, disparity, pediatric organ transplantation 2 of 33 | REA et al. 1 | INTRODUC TI ON Equitable access to organ transplantation and subsequent transplantrelated medical care is a critical goal across healthcare centers. Over the years, studies have identified risk factors impacting listing status and transplant-related outcomes, with greater scrutiny recently on clinical tools impacting organ allocation, selection, and donation processes. 1 These steps are critical in identifying areas of structural racism which continue to impact Black, Indigenous, and people of color as well as the intersectionality of socioeconomic factors within the patient population as a whole. To summarize findings to date, a systematic review of the available literature was conducted. Studies included assessments of SDoH in the evaluation, listing, and post-transplant periods. The US Department of Health and Human Services identifies five domains of SDoH that include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. 2 Special consideration was given to dynamic interplay between these factors to better understand social processes underlying health outcomes and identify potential intervention areas. | ME THODS | Search strategyThis systematic review is in accordance with PRISMA guidelines.Comprehensive search strategies were created for Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature, including controlled vocabulary terms from each database combined logically with keywords using Boolean Logic. Terms were extracted per the following concepts: pediatrics, organ transplantation, disparities, and identity (see example searc...

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Section: Resultsmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

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“…Adequate management of health-related issues by patients and/or caregivers has been shown to be significantly influenced by their knowledge and competencies, summarised as health literacy 6. In recent work, we found migration-related limitations in communication and knowledge on organ donation in parents of CMC with kidney transplantation, but did neither assess language nor education levels, nor investigated medication understanding 7. In general paediatric care, lower levels of health literacy were associated with higher rates of medication misunderstandings and adherence errors, in particular in the context of more complex discharge instructions as are likely the rule in CMC population 4 8 9…”

Section: Introductionmentioning

confidence: 79%

Parents’ understanding of medication at discharge and potential harm in children with medical complexity

Selzer,

Eibensteiner,

Kaltenegger

et al. 2023

Arch Dis Child

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ObjectiveChildren with medical complexity (CMC) are among the most vulnerable patient groups. This study aimed to evaluate their prevalence and risk factors for medication misunderstanding and potential harm (PH) at discharge.Design and settingCross-sectional study at a tertiary care centre.Study populationCMC admitted at Medical University of Vienna between May 2018 and January 2019.InterventionCMC and caregivers underwent a structured interview at discharge; medication understanding and PH for adverse events were assessed by a hybrid approach.Main outcome measuresMedication misunderstanding rate; PH.ResultsFor 106 included children (median age 9.6 years), a median number of 5.0 (IQR 3.0–8.0) different medications were prescribed. 83 CMC (78.3%) demonstrated at least one misunderstanding, in 33 CMC (31.1%), potential harm was detected, 5 of them severe. Misunderstandings were associated with more medications (r=0.24, p=0.013), new prescriptions (r=0.23, p=0.019), quality of medication-related communication (r=−0.21, p=0.032), low level of education (p=0.013), low language skills (p=0.002) and migratory background (p=0.001). Relative risk of PH was 2.27 times increased (95% CI 1.23 to 4.22) with new medications, 2.14 times increased (95% CI 1.10 to 4.17) with migratory background.ConclusionDespite continuous care at a tertiary care centre and high level of subjective satisfaction, high prevalence of medication misunderstanding with relevant risk for PH was discovered in CMC and their caregivers. This demonstrates the need of interventions to improve patient safety, with stratification of medication-related communication for high-risk groups and a restructured discharge process focusing on detection of misunderstandings (‘unknown unknowns’).

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“… 11 , 12 More favorable attitudes toward living donation may explain the highest 5-year probability of LDKT among Eastern European-born patients relative to their non-European-born referents. 14 , 24 Besides, the highest rate of withdrawal from the WL among EU-born subjects may be associated with their older age and higher presence of comorbidities relative to immigrant groups. 25 …”

Section: Discussionmentioning

confidence: 99%

“…foreign-born) migrants of non-European origin. 9 However, although most health systems in the EU guarantee equal access to KT, most 2 , 10–13 but not all 14 , 15 EU studies demonstrate disparities similar to those in the USA, especially regarding LDKT. Research on the association between immigration background and likelihood of KT remains limited in Europe and none has assessed KT likelihood after wait-listing.…”

Section: Introductionmentioning

confidence: 99%

Kidney transplantation and withdrawal rates among wait-listed first-generation immigrants in Italy

Grossi

Puoti

Fiaschetti

et al. 2022

European Journal of Public Health

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Background Multiple barriers diminish access to kidney transplantation (KT) in immigrant compared to non-immigrant populations. It is unknown whether immigration status reduces the likelihood of KT after wait-listing despite universal healthcare coverage with uniform access to transplantation. Methods We retrospectively collected data of all adult waiting list (WL) registrants in Italy (2010–20) followed for 5 years until death, KT in a foreign center, deceased-donor kidney transplant (DDKT), living-donor kidney transplant (LDKT) or permanent withdrawal from the WL. We calculated adjusted relative probability of DDKT, LDKT and permanent WL withdrawal in different immigrant categories using competing-risks multiple regression models. Results Patients were European Union (EU)-born (n = 21 624), Eastern European-born (n = 606) and non-European-born (n = 1944). After controlling for age, sex, blood type, dialysis vintage, case-mix and sensitization status, non-European-born patients had lower LDKT rates compared to other immigrant categories: LDKT adjusted relative probability of non-European-born vs. Eastern European-born 0.51 (95% CI: 0.33–0.79; P = 0.002); of non-European-born vs. EU-Born: 0.65 (95% CI: 0.47–0.82; P = 0.001). Immigration status did not affect the rate of DDKT or permanent WL withdrawal. Conclusions Among EU WL registrants, non-European immigration background is associated with reduced likelihood of LDKT but similar likelihood of DDKT and permanent WL withdrawal. Wherever not available, new national policies should enable coverage of travel and medical fees for living-donor surgery and follow-up for non-resident donors to improve uptake of LDKT in immigrant patients, and provide KT education that is culturally competent, individually tailored and easily understandable for patients and their potential living donors.

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High Rate of Living Kidney Donation to Immigrant Children Despite Disparities—An Epidemiological Paradox?

Cited by 7 publications

References 29 publications

A systematic review of social determinants of health in pediatric organ transplant outcomes

A systematic review of social determinants of health in pediatric organ transplant outcomes

Parents’ understanding of medication at discharge and potential harm in children with medical complexity

Kidney transplantation and withdrawal rates among wait-listed first-generation immigrants in Italy

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