Segregated residential and transplant center neighborhoods contribute to disparities
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Key takeaways:
- Black adults had a 10% lower access to living donor kidney transplants vs. white candidates.
- Candidates from neighborhoods with no more than 30% white residents had a 17% lower access to transplant.
Segregated residential and transplant center neighborhoods may serve as a mechanism of structural racism and contribute to disparities, according to a recently published study.
“Live donor kidney transplantation (LDKT) remains the preferred method of kidney replacement therapy,” Yiting Li, MPH, of the department of surgery at the New York University Grossman School of Medicine, wrote with colleagues. However, segregation is “associated with disparities in access to LDKT because potential donors often come from the same residential neighborhoods or social networks as candidates, and both donors and candidates must be evaluated by the transplant center.”
The cohort study ran from 1995 to 2021 and included 162,587 adult “non-Hispanic Black” or white first-time living kidney transplant candidates in the U.S. national transplant registry. Researchers used data from the Scientific Registry of Transplant Recipients, which includes information on all donors, wait-listed candidates and patients who had transplants in the U.S., submitted Organ Procurement and Transplantation Network.
Median age was 51.6 years; 49.2% of candidates were Black and 50.8% were white. During a median follow-up of 1.9 years, researchers analyzed segregation levels at patients’ residential and transplant center neighborhoods.
Findings showed Black candidates in high-segregation neighborhoods had a 10% lower access to LDKT compared with white candidates in low-segregation areas. Both Black and white adults listed at transplant centers in high-segregation neighborhoods faced reduced access to LDKT compared with those listed at centers in low-segregation neighborhoods.
Investigators also found that within high-segregation transplant center neighborhoods, candidates from predominantly underserved neighborhoods (those with 30% or fewer white residents) had a 17% lower access to LDKT compared with those from predominantly white neighborhoods. Further, researchers found that Black adults living in or listed at transplant centers in predominantly underserved neighborhoods had a lower likelihood of LDKT relative to white candidates in or listed at centers in predominantly white neighborhoods (65% and 64%, respectively).
Overall, the study “highlights the considerable role of racial and ethnic segregation in both the candidate’s residential neighborhood and the transplant center’s neighborhood,” according to Li and colleagues. “Continued research and collaborative efforts are necessary to ascertain specific social and built-environmental barriers of residential and transplant center neighborhoods that reinforce structural racism and influence access to LDKT.”
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