Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association−European Dialysis and Transplant Association) Registry

Tjaden, Lidwien A.; Noordzij, Marlies; Stralen, Karlijn J. van; Kuehni, Claudia E.; Raes, Ann; Cornelissen, Elisabeth A.M.; O’Brien, Catherine; Papachristou, Fotiοs; Schaefer, Franz; Groothoff, Jaap W.; Jager, Kitty J.

doi:10.1053/j.ajkd.2015.09.023

Cited by 62 publications

(55 citation statements)

References 36 publications

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“…Similar to findings by Patzer et al, Hispanic patients showed a significantly lower likelihood of transplantation compared to whites, but mainly in the older age group of 19–20 years (3). Prior studies have suggested that possible reasons contributing to racial-ethnic differences in access to kidney transplants beyond socio-economic differences were decreased access to living related donors, potential physician racial bias in belief of treatment success and life value, socio-cultural beliefs regarding transplants, lack of education, social support or parental oversight assisting with treatment adherence, and worse pre-dialysis care (3, 25). …”

Section: Discussionmentioning

confidence: 99%

Racial–ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients

et al. 2016

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Importance Previous studies in adult hemodialysis patients have shown that African-American and Hispanic patients have lower mortality risk as well as lower likelihood of kidney transplantation. However, studies of the association between race and outcomes in pediatric dialysis are sparse and often do not examine outcomes in Hispanic children. Objective To determine if racial-ethnic disparities in mortality and kidney transplantation outcomes exist in pediatric dialysis patients. Design, setting, and participants Retrospective cohort analysis of 2,697 pediatric dialysis patients (ages 0–20 years) from a large national dialysis organization (entry period 2001–2011) Exposures Race-ethnicity (non-Hispanic white, African-American, Hispanic) Main Outcomes and Measures Associations of race-ethnicity with mortality and kidney transplantation outcomes were examined separately using competing risks methods. Logistic regression analyses were used to examine the association between race-ethnicity with outcomes within one year of dialysis initiation. Results Of the 2,697 pediatric patients in this cohort, 895 were African-American, 778 were Hispanic, and 1,024 were non-Hispanic white. After adjusting for baseline demographics, competing risk survival analysis revealed that compared to non-Hispanic whites, African-Americans had a 64% higher mortality risk (HR = 1.64; 95% CI, 1.24, 2.17) while Hispanics had a 31% lower mortality risk (HR = 0.69; 95% CI, 0.47, 1.01) that did not reach statistical significance. African-Americans also had a higher odds of one-year mortality after starting dialysis (OR=2.08; 95% CI, 0.95, 4.58), while both African-Americans and Hispanics had a lower odds of receiving a transplant within one year of starting dialysis (OR=0.28; 95% CI, 0.19, 0.41 and OR=0.43; 95% CI, 0.31, 0.59, respectively). Conclusions and Relevance In contrast to adults, African-American pediatric dialysis patients have worse survival compared to their non-Hispanic white counterparts, while Hispanics have similar to lower mortality risk. Both African-American and Hispanic pediatric dialysis patients had lower likelihood of kidney transplantation compared to non-Hispanic whites, similar to observations in the adult dialysis population.

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Section: Discussionmentioning

confidence: 99%

Racial–ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients

et al. 2016

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“…Black and Hispanic adults treated with dialysis have been shown to have longer survival compared with non-Hispanic white adults, despite potential adverse social and socioeconomic positions that may predispose to poorer health outcomes, including lower access to transplantation. [8][9][10][11]24,26,29,[31][32][33] Although studies in the pediatric population have also shown marked disparities in access to transplantation in non-Hispanic black and Hispanic children and worsened graft survival in non-Hispanic black children, 24,26,29,34 our study is novel in its focus on the risk of death by race and ethnicity in children treated with dialysis and transplantation using data from a large United States cohort. We found that the risk of death was significantly higher in non-Hispanic black children beginning RRT compared with non-Hispanic white children but that access to transplantation seemed to mediate the differential risk of mortality.…”

Section: Discussionmentioning

confidence: 99%

“…24,28 A recent European registry study of children treated with RRT suggested a trend toward lower risk of death in black children, although few black children were included in the study, and the observation did not achieve statistical significance. 29 A prior study using the US Renal Data System (USRDS) suggested a higher relative risk of death in black versus white children treated with dialysis, 30 but the focus of this study was not on racial disparities and their potential explanatory factors. Because children have ready access to health care, higher priority on the transplant waitlist than most adults, and fewer comorbid conditions, which may reduce the potential for confounding, the study of racial disparities in the survival of children may be informative to our overall understanding of differences in mortality outcomes by race.…”

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confidence: 96%

Racial and Ethnic Disparities in Survival of Children with ESRD

Ku¹,

McCulloch

Grimes

et al. 2016

JASN

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Observational studies have reported that black and Hispanic adults receiving maintenance dialysis survive longer than non-Hispanic white counterparts. Whether there are racial disparities in survival of children with ESRD is not clear. We compared mortality risk among non-Hispanic black, Hispanic, and non-Hispanic white children who started RRT between 1995 and 2011 and were followed through 2012. We examined all-cause mortality using adjusted Cox models. Of 12,123 children included for analysis, 1600 died during the median follow-up of 7.1 years. Approximately 25% of children were non-Hispanic black, and 26% of children were of Hispanic ethnicity. Non-Hispanic black children had a 36% higher risk of death (95% confidence interval [95% CI], 1.21 to 1.52) and Hispanic children had a 34% lower risk of death (95% CI, 0.57 to 0.77) than non-Hispanic white children. Adjustment for transplant as a time-dependent covariate abolished the higher risk of death in non-Hispanic black children (hazard ratio, 0.99; 95% CI, 0.88 to 1.12) but did not attenuate the finding of a lower risk of death in Hispanic children (hazard ratio, 0.59; 95% CI, 0.51 to 0.68). In conclusion, Hispanic children had lower mortality than non-Hispanic white children. Non-Hispanic black children had higher mortality than non-Hispanic white children, which was related to differences in access to transplantation by race. Parity in access to transplantation in children and improvements in strategies to prolong graft survival could substantially reduce disparities in mortality risk of non-Hispanic black children treated with RRT.

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“…Although much of the research at the intersection of healthcare and race is conducted in the United States [20], the situation of minority groups is likely to be similar in Europe [10]. For instance, a large European study on end-stage renal disease demonstrated that "black and Asian patients were about half as likely to receive a kidney transplant as white patients, a finding that was not explained by differences in cause of kidney failure" [21]. The authors highlighted that disparities, both in terms of mortality on renal replacement therapy and decreased access to renal transplantation, could not be explained completely by the cause of kidney failure, and that other factors such as the socioeconomic, cultural, environmental and even other biological factors were likely to be involved [21].…”

Section: Introductionmentioning

confidence: 99%

“…For instance, a large European study on end-stage renal disease demonstrated that "black and Asian patients were about half as likely to receive a kidney transplant as white patients, a finding that was not explained by differences in cause of kidney failure" [21]. The authors highlighted that disparities, both in terms of mortality on renal replacement therapy and decreased access to renal transplantation, could not be explained completely by the cause of kidney failure, and that other factors such as the socioeconomic, cultural, environmental and even other biological factors were likely to be involved [21]. Moreover, it is worrying that little is known on the epidemiological profile of minority groups in European high-income countries due to their often unfortunate exclusion in epidemiological studies [22].…”

Section: Introductionmentioning

confidence: 99%

Structural racism in precision medicine: leaving no one behind

et al. 2020

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Background: Precision medicine (PM) is an emerging approach to individualized care. It aims to help physicians better comprehend and predict the needs of their patients while effectively adopting in a timely manner the most suitable treatment by promoting the sharing of health data and the implementation of learning healthcare systems. Alongside its promises, PM also entails the risk of exacerbating healthcare inequalities, in particular between ethnoracial groups. One often-neglected underlying reason why this might happen is the impact of structural racism on PM initiatives. Raising awareness as to how structural racism can influence PM initiatives is paramount to avoid that PM ends up reproducing the pre-existing health inequalities between different ethnoracial groups and contributing to the loss of trust in healthcare by minority groups. Main body: We analyse three nodes of a process flow where structural racism can affect PM's implementation. These are: (i) the collection of biased health data during the initial encounter of minority groups with the healthcare system and researchers, (ii) the integration of biased health data for minority groups in PM initiatives and (iii) the influence of structural racism on the deliverables of PM initiatives for minority groups. We underscore that underappreciation of structural racism by stakeholders involved in the PM ecosystem can be at odds with the ambition of ensuring social and racial justice. Potential specific actions related to the analysed nodes are then formulated to help ensure that PM truly adheres to the goal of leaving no one behind, as endorsed by member states of the United Nations for the 2030 Agenda for Sustainable Development. Conclusion: Structural racism has been entrenched in our societies for centuries and it would be naïve to believe that its impacts will not spill over in the era of PM. PM initiatives need to pay special attention to the discriminatory and harmful impacts that structural racism could have on minority groups involved in their respective projects. It is only by acknowledging and discussing the existence of implicit racial biases and trust issues in healthcare and research domains that proper interventions to remedy them can be implemented.

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Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association−European Dialysis and Transplant Association) Registry

Cited by 62 publications

References 36 publications

Racial–ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients

Racial–ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients

Racial and Ethnic Disparities in Survival of Children with ESRD

Structural racism in precision medicine: leaving no one behind

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