Has the Department of Veterans Affairs Found a Way to Avoid Racial Disparities in the Evaluation Process for Kidney Transplantation?
Has the Department of Veterans Affairs Found a Way to Avoid Racial Disparities in the Evaluation Process for Kidney Transplantation?
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DOI：
10.1097/tp.0000000000001377
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发表时间：
2017-06
期刊：
影响因子：
6.2
通讯作者：
Myaskovsky L
中科院分区：
文献类型：
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作者：
Freeman MA;Pleis JR;Bornemann KR;Croswell E;Dew MA;Chang CH;Switzer GE;Langone A;Mittal-Henkle A;Saha S;Ramkumar M;Adams Flohr J;Thomas CP;Myaskovsky L
少数群体受到退伍军人事务部（VA）和非VA移植中心肾移植（KT）的显着差异的影响。但是，之前的VA研究仅限于回顾性的二级数据库分析，同时关注KT过程的多个阶段。我们的目标是确定在评估期间是否存在差异KT在VA已被发现在非VA设置。我们对在4个国家VA KT中心接受KT初步评价的602例患者进行了一项多中心纵向队列研究。参与者完成了电话采访，以确定在控制医疗因素后，接受移植的时间差异是否可以通过患者的人口统计学，文化，心理社会或移植知识因素来解释。接受KT的时间无显著种族差异[对数秩χ2 =1.04; p=0.594]。低龄化（HR 0.98; 95% CI 0.97-0.99），合并症较少（HR 0.89; 95% CI 0.84-0.95），已婚（风险比0.81; 95%置信区间0.66-0.99），有私人和公共保险（HR 1.29; 95% CI 1.03-1.51）和中度或更高水平的抑郁（HR 1.87; 95% CI 1.03-3.29）预测接受时间较短。对KT类型（已故或活体供体）和移植中心位置的偏好对接受日期的影响随时间而变化。我们的研究结果表明，VA国家移植系统并没有表现出种族差异，在评估KT已被发现在非VA移植中心。
Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. But, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. We conducted a multi-center longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ2 =1.04; p=0.594]. Younger age (HR 0.98; 95% CI 0.97–0.99), fewer comorbidities (HR 0.89; 95% CI 0.84–0.95), being married (HR 0.81; 95% CI 0.66–0.99), having private and public insurance (HR 1.29; 95% CI 1.03–1.51), and moderate or greater levels of depression (HR 1.87; 95% CI 1.03–3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.