Racial disparities persist in living donor transplant independent of social vulnerability
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Racial disparities persist in access to living donor kidney transplantation regardless of social vulnerability, with Black patients being consistently less likely to receive a living donor kidney than their white counterparts, results show.
The findings, which were presented at the virtual American Transplant Congress, led Cozette Killian, MD, MPH, of University of Alabama at Birmingham Hospital, and colleagues to suggest implicit biases may play a role and should be considered in work focused on improving health equity.
“[Living donor kidney transplantation] LDKT inequities have largely been attributed to socioeconomic variability or contextual poverty level in the area where [patients] live,” Killian told the audience during her presentation. “Adjusting for factors such as neighborhood level poverty, education level and health insurance did decrease the disparity between white patients and minority patients. However, the association between LDKT and more comprehensive measures that better characterize the environment in which our patients live is not understood.”
To investigate, Killian and colleagues utilized data from the Scientific Registry of Transplant Recipients and identified all patients who underwent kidney transplantation in 2018 (6,158 with a living donor vs. 14,222 with a deceased donor).
Patients were grouped based on the CDC’s Social Vulnerability Index (SVI) which, Killian explained, uses 15 patient factors that fit in one of four primary categories (related to socioeconomic status, household composition and disability, minority status and language and housing type and transportation) that lead to a composite measure of overall social vulnerability.
“The CDC SVI was initially developed to help communities respond to natural disasters and epidemics, but prior work has demonstrated that SVI is associated with health characteristics, like obesity, which suggests that it may be a good surrogate for the social determinants of health,” Killian said.
Results showed that as social vulnerability increased, the probability of receiving a LDKT decreased; overall, a higher social vulnerability index was associated with a lower odds of LDKT (adjusted odds ratio = 0.47).
After controlling for social vulnerability index, researchers observed that Black patients had a 57% lower odds (aOR = 0.43) of LDKT compared with white patients.
“While racial disparities in LDKT are well recognized, I think it’s important to note that these disparities have actually increased in the last 2 decades,” Killian said.
“[Our study shows that] after accounting for variations in social vulnerability, racial disparities in LDKT still persisted; this suggests to us that we need to be giving greater attention to some of the other factors that may be contributing to these disparities, such as sociocultural barriers and implicit biases, in order to truly mitigate racial disparities in LDKT.”
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Killian C, et al. Live kidney donation. Presented at: American Transplant Congress; June 4 - June 9, 2021. (Virtual meeting).
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