Study: Blacks Less Likely to Get Kidneys

[okarol]

Study: Blacks Less Likely to Get Kidneys

By Samyukta Mullangi
Posted: 11/16/2007

A recent study by Emory researchers shows that poor black people with end-stage renal disease fared much worse than white people in the same demographic when being placed on the kidney transplant waiting list.

End-stage renal disease (ESRD) is a substantial health burden in the United States and prevalence increases every year, according to Rachel Patzer, lead author of the study and a Rollins School of Public Health student.

In an e-mail to the Wheel, Patzer wrote that in 2004 there were 336,000 dialysis patients in the United States. About 60,000 of these patients were placed on the transplant waiting list, and 17 percent of those received a transplant that year.

“In general, we found that as neighborhood poverty increases, the odds of waitlisting decreases for black patients compared to white patients,” Patzer wrote. “Even though ESRD is more prevalent among blacks, fewer blacks than whites actually receive a kidney transplant. Racial disparities exist in every step of the transplant process: from referral, to evaluation, waitlisting, and organ receipt.”

Patzer initially hypothesized that the distance from the patient’s residence to the transplant center would inversely affect the likelihood of being placed on the waiting list. She assumed that poverty would be secondary to distance in forming a barrier to obtaining full treatment.

Sandra Amaral, assistant professor of pediatrics and the co-author of the study, explained that for a procedure as intensive as a kidney transplant, patients have to come in to the transplant center for multiple visits and undergo numerous tests to be certified. If patients can’t make it, they can be listed as non-compliant, and therefore ineligible for the transplant.

But the team found that distance did not significantly affect the probability of being placed on the list. For the 12,572 patients studied, the average distance to the nearest transplant center was 49 miles.

“This result was a surprise positive finding,” Amaral said. “It shows that the transplant centers are doing a good job of mitigating the distance barrier in patient care.”

In contrast, there was a significant association between race and neighborhood poverty, so that in the poorest neighborhoods, blacks were 56 percent less likely to be placed on the waiting list than whites. There was no significant disparity between black and white patients in wealthy areas.

Surveillance data from Georgia and the Carolinas was compared with basic demographic data that is obtained from all dialysis patients diagnosed with end-stage renal disease. Patients’ residential addresses were linked to poverty data from the 2000 Census. Information about whether the patients were waitlisted over a seven-year period was obtained from the United Network for Organ Sharing registry and compared.

“This maybe just a reflection of limited resources, and perhaps racial disparity can be eliminated,” Amaral said. “We do not have information on the individual poverty levels, and our next step will be in that direction.”

The researchers said there could be many factors involved that need further study, including personal and cultural beliefs about transplantation, and physician perceptions about differential survival rates between blacks and whites.

Amaral said educating patients could bring about change.

“For instance, African Americans who are doing well on hemodialysis are less likely to obtain a transplant because they feel like they do not need it — we can address that,” she said. Also, Medicare generally pays for dialysis, but co-pays for surgery could be another barrier.

— Contact Samyukta Mullangi smullan@emory.edu

http://www.emorywheel.com/detail.php?n=24729

[Chris]

This should have been done at the same time of a previous article, if the writters are the same, of the earlier article you posted of blacks less likely to donate. That article kinda of touched on what this article is talking about.

[okarol]

Maybe poor blacks might not be readily waitlisted for a kidney transplant. Paying for immunosuppressive drugs for the life of the transplant might be a major obstacle.
If the patient looks like a bad long-term risk in terms of having coverage for the life-long medications needed, they would not be waitlisted.

As far as blacks receiving less transplants in general, I have heard that the majority of blacks are O blood type, which is the longest wait. Also, as Chris mentioned, there's a very significant lack of support in some black communities for living donation, so that is a much less likely option.