Evaluation of Community-Level Vulnerability and Racial Disparities in Living Donor Kidney Transplant
Evaluation of Community-Level Vulnerability and Racial Disparities in Living Donor Kidney Transplant
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DOI：
10.1001/jamasurg.2021.4410
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发表时间：
2021-09-15
期刊：
影响因子：
16.9
通讯作者：
Locke, Jayme E.
中科院分区：
文献类型：
--
作者：
Killian, A. Cozette;Shelton, Brittany;Locke, Jayme E.
重要性 活体肾移植 (LDKT) 是终末期肾病的理想治疗方法，但 LDKT 的种族差异在过去 20 年中有所增加。尽管尚未评估社区层面脆弱性的综合衡量标准，但受者的临床和社会因素并不能解释 LDKT 种族不平等。 目的 确定 LDKT 中的种族差异是否持续存在，与社区层面的脆弱性无关。 设计、设置和参与者 这项回顾性、多中心、横断面研究纳入了移植受者科学登记处 19 287 名成人仅接受肾脏移植的受者的数据。该研究纳入了 2018 年 1 月 1 日至 12 月 31 日期间接受移植的个体。暴露受者种族和 2018 年美国疾病控制与预防中心社会脆弱性指数 (SVI)。人口普查区级别的 SVI 数据与每个接收者邮政编码内的人口普查区相关联。邮政编码内人口普查区的中位 SVI 测量值用于描述社区层面的脆弱性。 主要结果和测量 肾移植捐献者类型（已故与活着）。使用改进的泊松回归来评估 SVI 和 LDKT 之间的关联，并估计种族之间 LDKT 的可能性，独立于社区级别的脆弱性和接受者级别的特征。 结果 在 19 287 名肾移植受者中，6080 名 (32%) 接受了 LDKT。共有 11 582 名 (60%) 为男性，中位年龄（四分位距）为 54 (43-63) 岁。有 760 名黑人 LDKT 接受者 (13%)、4865 名白人 LDKT 接受者 (80%) 和 455 名其他种族 LDKT 接受者 (7%；美洲印第安人、亚洲人、多种族和太平洋岛民)。与生活在 SVI 较低（即较不易受伤害）社区的受助者相比，居住在 SVI 较高社区（即较易受伤害）的受助者发生 LDKT 的可能性较低（调整后相对风险 [aRR]，0.97；95% CI，0.96-0.98；P
IMPORTANCE Living donor kidney transplant (LDKT) is the ideal treatment for end-stage kidney disease, but racial disparities in LDKT have increased over the last 2 decades. Recipient clinical and social factors do not account for LDKT racial inequities, although comprehensive measures of community-level vulnerability have not been assessed.OBJECTIVE To determine if racial disparities persist in LDKT independent of community-level vulnerability.DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter, cross-sectional study included data from 19 287 adult kidney-only transplant recipients in the Scientific Registry of Transplant Recipients. The study included individuals who underwent transplant between January 1 and December 31, 2018.EXPOSURES Recipient race and the 2018 US Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Census tract-level SVI data were linked to census tracts within each recipient zip code. The median SVI measure among the census tracts within a zip code was used to describe community-level vulnerability.MAIN OUTCOMES AND MEASURES Kidney transplant donor type (deceased vs living). Modified Poisson regression was used to evaluate the association between SVI and LDKT, and to estimate LDKT likelihood among races, independent of community-level vulnerability and recipient-level characteristics.RESULTS Among 19 287 kidney transplant recipients, 6080 (32%) received LDKT. A total of 11 582 (60%) were male, and the median (interquartile range) age was 54 (43-63) years. There were 760 Black LDKT recipients (13%), 4865 White LDKT recipients (80%), and 455 LDKT recipients of other races (7%; American Indian, Asian, multiracial, and Pacific Islander). Recipients who lived in communities with higher SVI (ie, more vulnerable) had lower likelihood of LDKT compared with recipients who lived in communities with lower SVI (ie, less vulnerable) (adjusted relative risk [aRR], 0.97; 95% CI, 0.96-0.98; P