The January 2018 issue of the Journal of the American Medical Association features the article “Association of Race and Ethnicity with Live Donor Kidney Transplantation in the United States From 1995 to 2014” authored by Tanjala S. Purnell and colleagues including Lisa Cooper, Deidra Crews and Ebony Boulware from the DOM. The study aims to estimate changes over time in racial/ethnic disparities in live donor kidney transplantation (LDKT) in the U.S. utilizing data from the Scientific Registry of Transplant Recipients between January 1995 to December 2014, with follow-up thorough December 2016. The articles notes that their findings exist amidst numerous interventions to address racial/ethnic disparities in LDKT including addressing barriers to knowledge, cultural concerns, attitudes, beliefs, behavior and policies to address economic barriers.
Of the over 450,000 adult kidney transplant candidates whose data was analyzed between 1995 and 2014, 13.1 percent received LDKT. The major findings from this article include the racial/ethnic differences in receipt of LDKT at two years after appearing on the waiting list in 1995 compared to 2014. Specifically, the cumulative incidence of LDKT increased from 7 percent to 11 percent among whites, decreased from 3.4 percent to 2.9 percent among blacks, decreased from 6.8 percent to 5.9 percent among Hispanics and increased 5.1 percent to 5.6 percent among Asians. Though after adjusting for relevant covariates, the authors noted subhazard ratios among blacks to change from .45 to .27, among Hispanics .83 to .52, and among Asians .56 to .42 over the same time interval compared to whites.
This eye-opening article spotlights how racial/ethnic disparities in receipt of LDKT among blacks, Hispanics and Asians persist despite efforts to reduce disparities. These findings arguably compel reflection upon the effectiveness of current efforts. The authors suggest that moving forward effectively may require the implementation of a national, evidence-based strategic initiative that is culturally and linguistically appropriate and includes proactive steps including the development of online communities and creation of infrastructure for patient navigation as well as the development of policies that standardize and increase the availability of kidney exchanges. The authors also call for increased collaboration among patients, policy makers and researchers. This work makes an important contribution to the author’s field of study, but also uniquely urges us to continually examine the effectiveness of strategies aimed at eliminating disparities in healthcare.
This article was featured as this week's Article of the Week. To view the full article, click here: https://jamanetwork.com/journals/jama/fullarticle/2667722?resultClick=1
-Thomas K.M. Cudjoe, fellow in Geriatrics
