Racial/Ethnic Differences in the Association between Hospitalization and Kidney Transplantation among Waitlisted End-Stage Renal Disease Patients

Kira L. Newman, Stacey A. Fedewa, Melanie H. Jacobson, Andrew B. Adams, Rebecca Zhang, Stephen O. Pastan, Rachel E. Patzer

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background Even after placement on the deceased donor waitlist, there are racial disparities in access to kidney transplant. The association between hospitalization, a proxy for health while waitlisted, and disparities in kidney transplant has not been investigated. Methods We used United States Renal Data System Medicare-linked data on waitlisted end-stage renal disease patients between 2005 and 2009 with continuous enrollment in Medicare Parts A & B (n = 24 581) to examine the association between annual hospitalization rate and odds of receiving a deceased donor kidney transplant. We used multilevel mixed effects models to estimate adjusted odds ratios, controlling for individual-, transplant center-, and organ procurement organization-level clustering. Results Blacks and Hispanics were more likely than whites to be hospitalized for circulatory system or endocrine, nutritional, and metabolic diseases (P < 0.001). After adjustment, compared with individuals not hospitalized, patients who were hospitalized frequently while waitlisted were less likely to be transplanted (>2 vs 0 hospitalizations/year adjusted odds ratios = 0.57; P < 0.001). Though blacks and Hispanics were more likely to be hospitalized than whites (P < 0.001), adjusting for hospitalization did not change estimated racial/ethnic disparities in kidney transplantation. Conclusions Individuals hospitalized while waitlisted were less likely to receive a transplant. However, hospitalization does not account for the racial disparity in kidney transplantation after waitlisting.

Original languageEnglish (US)
Pages (from-to)2735-2745
Number of pages11
JournalTransplantation
Volume100
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

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