In the US southeast, women with diabetes and ESKD see fewer referrals to transplantation
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Key takeaways:
- Women with type 2 diabetes-attributed ESKD were 13% less likely to be referred for transplantation than men.
- Women were also 14% less likely to be evaluated and 14% less likely to be waitlisted vs. men.
Women with ESKD are more likely than men to face kidney transplant-related disparities, according to a recently published study conducted in the southeast U.S.
“Reasons for this disparity have not been delineated, though some evidence ... include greater provider perceptions of frailty regarding female candidates, higher levels of obesity, higher psychosocial and health-related concerns and a lack of provider awareness of sex/gender-related disparities,” Jessica L. Harding, PhD, an epidemiologist at the Emory University School of Medicine in Atlanta, and colleagues wrote.
The study examined 43,548 adults aged 18 to 79 years with new-onset ESKD — in Georgia, North Carolina and South Carolina — between 2015 and 2019, using data from the United States Renal Data System and Early Steps to Transplant Access Registry. Researchers analyzed data and followed patients through 2020.
Specifically, investigators looked at referral rates within 12 months, evaluation start within 6 months and waitlist placement for kidney transplantation among different ESKD attributors, such as type 1 diabetes, type 2 diabetes, hypertension, glomerulonephritis and cystic disease.
Primary outcomes were referral, evaluation start and placement on the waitlist at various stages of care.
Overall, among all incident ESKD patients, 45.2% of women and 48.7% of men were referred within 12 months, according to the study. A total of 54.3% and 57.4% of referred women and men, respectively, started the evaluation within 6 months; and 48.9% and 49.4% of each sex who started the evaluation were placed on a waitlist. Meanwhile, 17.4% and 20% of women and men, respectively, were wait-listed among all incident dialysis patients.
According to the results, women with type 2 diabetes-attributed ESKD were 13% less likely to be referred, 14% less likely to be evaluated and 14% less likely to be placed on a waitlist compared to men with the same condition. Women with hypertension-attributed ESKD were 14% less likely to be referred and 8% less likely to be evaluated, the researchers found, but had similar waitlisting rates once evaluated. For patients with ESKD attributed to other causes, like type 1 diabetes, glomerulonephritis or cystic disease, there were no significant sex disparities in referral, evaluation or waitlisting rates.
It may be likely that “social determinants of health play a large role in explaining sex/gender-based disparities in transplant access,” Harding and colleagues wrote. “These results highlight the need to collect national data on pre-waitlisting steps to identify where in the transplant process inequities are occurring, and among which subgroup of the population they are concentrated.”
Editor’s note: On Sept. 13, 2023, the headline of the story was updated to clarify that the study was conducted in the U.S. southeast.
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