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

Abstract

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.

Racial Disparities in Access to Pediatric Kidney Transplantation Since Share 35

“…2 Historically, black pediatric ESRD patients have reduced access to the waiting list, wait longer to receive a transplant, and are more likely to experience graft failure compared with white pediatric ESRD patients. [3][4][5][6][7][8] The racial differences observed in pediatric kidney transplantation are multifactorial and likely influenced by a complex mixture of biologic, immunologic, and socioeconomic factors. Some of the factors that have been thought to play a role include decreased rates of living-donor (LD) kidneys and pre-emptive transplantation, greater histocompatibility mismatches, and lower socioeconomic status (SES) among black versus white pediatric ESRD patients.…”

“…Some of the factors that have been thought to play a role include decreased rates of living-donor (LD) kidneys and pre-emptive transplantation, greater histocompatibility mismatches, and lower socioeconomic status (SES) among black versus white pediatric ESRD patients. 3,[8][9][10][11] Little information has been reported on transplant access in Hispanic children with ESRD; however, the work by Leonard et al 4 found a reduced rate of transplantation among Hispanic versus white pediatric incident dialysis patients. The work by Patzer et al 8 recently reported reduced access to deceased-donor kidney transplantation (DDKT) for both black and Hispanic pediatric incident ESRD patients compared with whites, even after adjusting for individual and neighborhoodlevel measures of SES.…”

“…However, disparities in access to the waiting list were mitigated in Hispanics with private health insurance. 8 Since Share 35, pediatric ESRD patients have experienced shorter waiting times for DDKT, but the rate of LD transplants has decreased; additionally, the degree of HLA mismatch from DDKs is greater. [12][13][14] How the implementation of Share 35 has affected racial disparities in pediatric kidney transplant access has not yet been explored.…”

Inequalities in access to pediatric ESRD care: a global health challenge

“…Ethnic minorities, women, older adults, patients with lower socioeconomic status, and those on dialysis at a for-profit center are less likely to undergo kidney transplantation. Among pediatric patients, ethnic minorities tend to have reduced access to the transplant waiting list, have reduced access to deceased donor transplantation once on the waiting list [32], and to livingdonor preemptive transplantation [33]. Although ethnicity and social deprivation are closely related, socioeconomic status does not explain all ethnic differences in access to pediatric kidney transplantation in the US [32].…”

“…Among pediatric patients, ethnic minorities tend to have reduced access to the transplant waiting list, have reduced access to deceased donor transplantation once on the waiting list [32], and to livingdonor preemptive transplantation [33]. Although ethnicity and social deprivation are closely related, socioeconomic status does not explain all ethnic differences in access to pediatric kidney transplantation in the US [32]. A change in the national allocation policy in 2005, which gave a higher priority to pediatric candidates, has attenuated, but not eliminated, these ethnic disparities [34].…”