Perceived discrimination predicts longer time to be accepted for kidney transplant.
Perceived discrimination predicts longer time to be accepted for kidney transplant.
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DOI：
10.1097/tp.0b013e318241d0cd
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发表时间：
2012-02-27
期刊：
影响因子：
6.2
通讯作者：
Shapiro R
中科院分区：
文献类型：
--
作者：
Myaskovsky L;Almario Doebler D;Posluszny DM;Dew MA;Unruh M;Fried LF;Switzer GE;Kim S;Chang CC;Ramkumar M;Shapiro R
虽然非裔美国人（AAs）的终末期肾病（ESKD）是白人的四倍，但AAs接受肾移植（KT）的可能性不到一半。即使在控制了临床因素（如合并症、透析年份和类型以及潜在活体供体的可用性）后，也发现了这种种族差异。因此，研究非医学因素对于理解KT的差异至关重要。我们对127例接受KT评价的AA和白色ESKD患者进行了一项纵向队列研究（12/06 - 7/07），以确定在控制医学因素后，接受移植时间的差异是否可以由患者的文化因素（例如，感知到的种族主义和歧视、医学上的不信任、对活体供体KT的宗教反对），心理社会特征（例如，社会支持、焦虑、抑郁）或移植知识。参与者完成了2次电话采访（在开始移植评估后不久，以及在被接受或发现不符合移植条件后）。结果表明，AA患者报告的文化因素水平高于白人。我们发现，在合并症或潜在的活体供体的可用性没有差异。AA比白人需要更长的时间才能接受移植（HR=1.49，p=0.005）。在调整人口统计学、心理社会学和文化因素后，种族与上市时间较长的关联不再显著。我们建议，干预措施，以解决种族差异的KT纳入关键的非医疗风险因素的患者。
Although end-stage kidney disease (ESKD) in African Americans (AAs) is four times greater than in Whites, AAs are less than half as likely to undergo kidney transplantation (KT). This racial disparity has been found even after controlling for clinical factors such as co-morbid conditions, dialysis vintage and type, and availability of potential living donors. Therefore, studying non-medical factors is critical to understanding disparities in KT. We conducted a longitudinal cohort study with 127 AA and White patients with ESKD undergoing evaluation for KT (12/06 – 7/07) to determine whether, after controlling for medical factors, differences in time to acceptance for transplant is explained by patients’ cultural factors (e.g., perceived racism and discrimination, medical mistrust, religious objections to living donor KT), psychosocial characteristics (e.g., social support, anxiety, depression), or transplant knowledge. Participants completed 2 telephone interviews (shortly after initiation of transplant evaluation and after being accepted or found ineligible for transplant). Results indicated that AA patients reported higher levels of the cultural factors than did Whites. We found no differences in co-morbidity or availability of potential living donors. AAs took significantly longer to get accepted for transplant than did Whites (HR=1.49, p=0.005). After adjustment for demographic, psychosocial, and cultural factors, the association of race with longer time for listing was no longer significant. We suggest that interventions to address racial disparities in KT incorporate key non-medical risk factors in patients.