Gender and Racial Disparities in Provision of Transplant Information in Elderly Dialysis Patients

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Abstract

Introduction

Kidney transplantation offers survival benefit and improved quality of life in end stage renal disease (ESRD) patients. Elderly represent the highest growth among incident ESRD. However, after considering the influence of pre-dialysis health status, the effects of race and gender on provision of transplant information during dialysis initiation in elderly dialysis patients remains unknown.

Methods

We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United States Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Information on pre-dialysis health status was obtained from form 2728 and linked Medicare claims. Using logistic regression models adjusted for 18 covariates; we examined the effect of gender and race on provision of transplant information in elderly dialysis patients.

Results

Of the study cohort, 45% were female, 62% were White and 26% were octogenarian. Mean age was 72±11 years. Of ESRD patients, only 66% were informed of transplant option at time of 2728 filing. Pre-dialysis nephrology care was received by 59% of patients and pre-dialysis acute hospitalization occurred in 89% of patients. Overall, one-year mortality was 31%; it was 28% in patients those informed about kidney transplant option and 38% in those that were not informed (P<0.001). Whites received more pre-dialysis nephrology care as compared to Asians, Blacks and Hispanics (61% vs. 59% vs. 57% vs. 54%, p<0.001). Females received less pre-dialysis nephrology care than males (58.6% vs. 60%, p=0.002). Whites had the lowest rate of being informed about kidney transplant, whereas Asians had the highest rate of being informed (64% vs. 72%, p value <0.001). Fewer females were informed about kidney transplant than males (65% vs. 66%, p=0.003). In adjusted analyses, Blacks, Hispanics and Asians were more likely to be informed of transplant option at the time of dialysis initiation as compared to Whites [(odds ratio [OR] = 1.14, 95% confidence interval [CI], 1.09-1.19), OR= 1.07, CI, 1.00-1.15) and OR=1.35, CI, 1.198-1.520]. Females were less likely to be informed of transplant option than males (OR = 0.94, CI, 0.90-0.98).

Conclusion

Among elderly Medicare beneficiaries’, as compared to Whites, Blacks are 7% more likely, Hispanics are 14% more likely and Asians are 35% more likely to get provision of transplant information. Females are 6% less likely than males to get provision of transplant information. These differences across race and gender are independent of pre-dialysis heath status, among other factors. Further studies are needed to address race and gender based barriers to access to transplantation at the time of dialysis initiation.

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