The Effect of Race and Income on Living Kidney Donation in the United States
The Effect of Race and Income on Living Kidney Donation in the United States
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DOI：
10.1681/asn.2013010049
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发表时间：
2013-11-01
影响因子：
13.6
通讯作者：
Gill, John
中科院分区：
文献类型：
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作者：
Gill, Jagbir;Dong, James;Gill, John
活体肾移植的种族差异的研究主要集中在患者因素，而供体因素仍然在很大程度上未经审查。在这里，来自美国人口普查局的数据与1998年至2010年期间在器官共享联合网络（UNOS）注册的美国所有非洲裔美国人和白色活体肾脏捐赠者的数据（N= 57，896）相结合，以检查活体肾脏捐赠（LKD）与捐赠者家庭收入中位数和种族之间的关联。LKD的相对发病率是在调整了年龄、性别、ESRD率和地理位置后，按家庭收入中位数排列的邮政编码五分位数确定的。在非裔美国人和白色人群中，LKD的发病率在高收入人群中更高。值得注意的是，非裔美国人的LKD总发病率高于白色人群（发病率比[IRR]，1.20; 95%置信区间[95% CI]，1.17 - 1.24]），但比值因收入而异。在收入最低的五分之一人群中，非裔美国人的LKD发病率低于白色人（内部收益率，0.84; 95%CI，0.78至0.90），但在三个最高收入五分之一的非洲裔美国人中较高，内部收益率为1.31（95% CI，1.22至1.41），Q4为1.50（95% CI，1.39至1.62），Q5为1.87（95% CI，1.73至2.02）。因此，这些数据表明，在获得活体供体移植的种族差异可能是由于社会经济因素，而不是在接受LKD的文化差异。
Studies of racial disparities in access to living donor kidney transplantation focus mainly on patient factors, whereas donor factors remain largely unexamined. Here, data from the US Census Bureau were combined with data on all African-American and white living kidney donors in the United States who were registered in the United Network for Organ Sharing (UNOS) between 1998 and 2010 (N=57,896) to examine the associations between living kidney donation (LKD) and donor median household income and race. The relative incidence of LKD was determined in zip code quintiles ranked by median household income after adjustment for age, sex, ESRD rate, and geography. The incidence of LKD was greater in higher-income quintiles in both African-American and white populations. Notably, the total incidence of LKD was higher in the African-American population than in the white population (incidence rate ratio [IRR], 1.20; 95% confidence interval [95% CI], 1.17 to 1.24]), but ratios varied by income. The incidence of LKD was lower in the African-American population than in the white population in the lowest income quintile (IRR, 0.84; 95% CI, 0.78 to 0.90), but higher in the African-American population in the three highest income quintiles, with IRRs of 1.31 (95% CI, 1.22 to 1.41) in Q3, 1.50 (95% CI, 1.39 to 1.62) in Q4, and 1.87 (95% CI, 1.73 to 2.02) in Q5. Thus, these data suggest that racial disparities in access to living donor transplantation are likely due to socioeconomic factors rather than cultural differences in the acceptance of LKD.