Universal health care in US could mitigate racial disparities in kidney transplant results
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A study of graft loss in black and white kidney transplant recipients in the U.S. Military Health System suggested broader implementation of a universal health care model could lessen racial disparities in outcomes after transplant.
“Racial disparities in kidney transplant outcomes are well documented and are attributed to biologic differences, immunologic factors and other barriers, including lower socioeconomic status, nonadherence to immunosuppressive medications, reduced access to care and policies related to the kidney allocation system,” Crystal J. Forman, MD, of the San Antonio Uniformed Services Health Education Consortium, and colleagues wrote in a research letter. “Although recent findings of reduced disparities in graft survival are encouraging, achieving broad-based equity in health outcomes is still a work in progress.”
According to the researchers, the U.S. Military Health System is a universal health care system model which has few barriers to accessing care, regardless of socioeconomic status. Seeking to determine the impact of universal health care on graft outcomes, the researchers assessed differences in graft survival between 205 black patients and 196 white patients in the U.S. Military Health System.
Before adjusting for demographic, clinical and socioeconomic characteristics, analyses demonstrated black patients had lower overall graft survival at 10 years after transplant compared with white patients (0.56 vs. 0.70).
Researchers found, however, that after making adjustments for these factors, the risk of overall graft loss for black patients in the U.S. Military Health System vs. white patients was not significant (adjusted hazard ratio [aHR]= 0.89). For comparison, they also looked at a cohort from the general population (not in the U.S. Military Health System) and determined black recipients had a significantly increased risk of overall graft loss compared with white recipients, even after accounting for these variables (aHR = 1.08).
“The effect of social determinants of health on graft survival are well documented, and may have partly contributed to parity in the adjusted risk of graft loss between [U.S. Military Health System] MHS black and white patients,” the researchers wrote, noting that black and white patients in the MHS had similar socioeconomic status, while black patients in the MHS had higher socioeconomic status than black patients in the general transplant population.
Based on these findings, they contended that “MHS beneficiaries enjoy comprehensive health care benefits in an integrated system, and universal access to care likely played a role to include lifelong coverage of [immunosuppressive therapy] IST with no out-of-pocket expenses, which would improve transplant outcomes and medication adherence.”
According to the researchers, an effective next step would be the U.S. Senate and House of Representatives implementing such coverage under the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019.
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