Disparities in the Utilization of Live Donor Renal Transplantation
Disparities in the Utilization of Live Donor Renal Transplantation
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DOI：
10.1111/j.1600-6143.2009.02620.x
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发表时间：
2009-05-01
影响因子：
8.8
通讯作者：
Singer, J. S.
中科院分区：
文献类型：
--
作者：
Gore, J. L.;Danovitch, G. M.;Singer, J. S.
尽管医疗保险覆盖全民，但社会人口差异混淆了肾衰竭患者的护理。我们试图确定是否成年人谁实现获得肾移植遭受不公平的利用活体供肾移植（LDRT）。我们从器官共享联合网络（UNOS）中确定了2004-2006年接受初次肾移植的成年人。我们在多变量模型上模拟了活体与死亡供体肾移植的接受情况，该模型检查了受体、中心和UNOS区域特异性协变量。在确定的41090名成人受者中，39%接受了LDRT。在多变量分析中，老年接受者（50-59岁受试者与18-39岁受试者的OR 0.62，95% CI 0.56-0.68），非裔美国人（相对于白人，OR 0.54，95% CI 0.50-0.59）和社会经济地位较低（高中教育与大学教育受试者OR 0.72，95%CI 0.67-0.79;最低与最高收入四分位数OR 0.78，95%CI 0.71-0.87）LDRT的几率较低。这些特征占LDRT变异的14.2%，超过受者临床变量、移植中心特征和UNOS区域水平变异。我们发现在LDRT的使用中存在显著的种族和社会经济差异。教育举措和传播能够增加LDRT利用率的过程可能会解决这些差异。
Despite universal payer coverage with Medicare, sociodemographic disparities confound the care of patients with renal failure. We sought to determine whether adults who realize access to kidney transplantation suffer inequities in the utilization of live donor renal transplantation (LDRT). We identified adults undergoing primary renal transplantation in 2004-2006 from the United Network for Organ Sharing (UNOS). We modeled receipt of live versus deceased donor renal transplant on multilevel multivariate models that examined recipient, center and UNOS region-specific covariates. Among 41 090 adult recipients identified, 39% underwent LDRT. On multivariate analysis, older recipients (OR 0.62, 95% CI 0.56-0.68 for 50-59 year-olds vs. 18-39 year-old recipients), those of African American ethnicity (OR 0.54, 95% CI 0.50-0.59 vs. whites) and of lower socioeconomic status (OR 0.72, 95% CI 0.67-0.79 for high school-educated vs. college-educated recipients; OR 0.78, 95% CI 0.71-0.87 for lowest vs. highest income quartile) had lower odds of LDRT. These characteristics accounted for 14.2% of the variation in LDRT, more than recipient clinical variables, transplant center characteristics and UNOS region level variation. We identified significant racial and socioeconomic disparities in the utilization of LDRT. Educational initiatives and dissemination of processes that enable increased utilization of LDRT may address these disparities.