Does Racial Disparity in Kidney Transplant Wait-listing Persist After Accounting for Social Determinants of Health?

BACKGROUND: African Americans have lower rates of kidney transplantation (KT) compared to Whites, even after adjusting for demographic and medical factors. In this study, we examined whether racial disparity in KT wait-listing persists after adjusting for social determinants of health (e.g. cultural, psychosocial, knowledge). METHODS: We prospectively followed a cohort of 1055 patients who were evaluated for KT between 3/10-10/12 and followed through 8/18. Participants completed a semi-structured telephone interview shortly after their first KT evaluation appointment. We used Wilcoxon rank-sum and Pearson chi-square tests to examine race differences in the baseline characteristics. We then assessed racial differences in the probability of wait-listing while accounting for all predictors using cumulative incidence curves and Fine & Gray proportional subdistribution hazards models. RESULTS: There were significant differences in the baseline characteristics between non-Hispanic African Americans (AA) and non-Hispanic Whites (WH). AA were 25% less likely (95% confidence interval, 0.60-0.96) to be wait-listed than WH even after adjusting for medical factors and social determinants of health. In addition, being older, having lower income, public insurance, more comorbidities, and being on dialysis decreased the probability of wait-listing while having more social support and transplant knowledge increased the probability of wait-listing. CONCLUSION: Racial disparity in kidney transplant wait-listing persisted even after adjusting for medical factors and social determinants of health, suggesting the need to identify novel factors that impact racial disparity in transplant wait-listing. Developing interventions targeting cultural and psychosocial factors may enhance equity in access to transplantation.