Association of Socioeconomic Status and Comorbidities with Racial Disparities during Kidney Transplant Evaluation
Association of Socioeconomic Status and Comorbidities with Racial Disparities during Kidney Transplant Evaluation
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DOI：
10.2215/cjn.12541019
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发表时间：
2020-06-08
影响因子：
9.8
通讯作者：
McAdams-DeMarco, Mara A.
中科院分区：
文献类型：
--
作者：
Murphy, Karly A.;Jackson, John W.;McAdams-DeMarco, Mara A.
背景和目的转介的黑人肾移植患者已经克服了许多障碍，但在移植前可能面临持续的种族差异。这些差异背后的机制尚不清楚。我们确定了社会经济地位（SES）和合并症作为上市和移植差异的中介因素的贡献。设计、环境、参与者和测量我们研究了一个队列（n=1452名黑人；n=1561名白人），这些患者被转诊并开始了移植过程（2009年至2018年）。我们使用Cox比例风险分析和反向优势比加权，估计了SES（自我报告的收入、教育和就业）和医疗合并症（自我报告和图表摘要）作为种族差异中介的直接和间接影响。在积极列出的983名黑人和1085名白人候选人中，我们使用负比值比加权的泊松回归估计了SES和合并症作为种族差异中介因素对移植接受的直接和间接影响。结果在第一年，有876名（60%）黑人患者和1028名（66%）白人患者进入了等待名单。与白人患者相比，黑人患者上市的相对风险为0.76(95%可信区间[95% CI]， 0.69 ~ 0.83)；经SES和合并症校正后，相对危险度为0.90 （95% CI, 0.83 ~ 0.97）。清单中种族差异的比例由SES解释为36% (95% CI， 26%至57%)，合并症解释为44% (95% CI， 35%至61%)，SES合并症解释为58% （95% CI， 44%至85%）。黑名单候选移植患者409例（42%），白名单候选移植患者496例（45%），中位随访时间分别为3.9年（四分位数范围1.2 ~ 7.1）和2.8年（四分位数范围0.8 ~ 6.3）年。黑人与白人候选人的发病率比为0.87 (95% CI， 0.79至0.96)；社会经济地位和共病并不能解释种族差异。结论社会经济地位和合并症在移植手术中部分介导了种族差异，而非种族差异。
Background and objectives Black patients referred for kidney transplantation have surpassed many obstacles but likely face continued racial disparities before transplant. The mechanisms that underlie these disparities are unclear. We determined the contributions of socioeconomic status (SES) and comorbidities as mediators to disparities in listing and transplant.Design, setting, participants, & measurements We studied a cohort (n=1452 black; n=1561 white) of patients with kidney failure who were referred for and started the transplant process (2009?2018). We estimated the direct and indirect effects of SES (self-reported income, education, and employment) and medical comorbidities (self-reported and chart-abstracted) as mediators of racial disparities in listing using Cox proportional hazards analysis with inverse odds ratio weighting. Among the 983 black and 1085 white candidates actively listed, we estimated the direct and indirect effects of SES and comorbidities as mediators of racial disparities on receipt of transplant using Poisson regression with inverse odds ratio weighting.Results Within the first year, 876 (60%) black and 1028 (66%) white patients were waitlisted. The relative risk of listing for black compared with white patients was 0.76 (95% confidence interval [95% CI], 0.69 to 0.83); after adjustment for SES and comorbidity, the relative risk was 0.90 (95% CI, 0.83 to 0.97). The proportion of the racial disparity in listing was explained by SES by 36% (95% CI, 26% to 57%), comorbidity by 44% (95% CI, 35% to 61%), and SES with comorbidity by 58% (95% CI, 44% to 85%). There were 409 (42%) black and 496 (45%) white listed candidates transplanted, with a median duration of follow-up of 3.9 (interquartile range, 1.2?7.1) and 2.8 (interquartile range, 0.8?6.3) years, respectively. The incidence rate ratio for black versus white candidates was 0.87 (95% CI, 0.79 to 0.96); SES and comorbidity did not explain the racial disparity.Conclusions SES and comorbidity partially mediated racial disparities in listing but not for transplant.