Racial disparities in access to renal transplantation - Clinically appropriate or due to underuse or overuse?
Racial disparities in access to renal transplantation - Clinically appropriate or due to underuse or overuse?
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DOI：
10.1056/nejm200011233432106
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发表时间：
2000-11-23
影响因子：
158.5
通讯作者：
Conti, RM
中科院分区：
文献类型：
--
作者：
Epstein, AM;Ayanian, JZ;Conti, RM
背景：尽管有大量证据表明外科手术的使用存在种族差异，但尚不确定这些差异是否反映了临床适宜性或过度使用或使用不足的种族差异。方法：我们进行了文献回顾，并使用一个专家小组来制定确定终末期肾病患者肾移植是否合适的标准。使用来自五个州和哥伦比亚特区的1996年或1997年开始接受透析的患者的数据，我们随机选择了1518名患者（年龄范围，18至54岁），根据种族和性别分层。我们对移植患者的适宜性进行了分类，并根据种族分析了转介到移植中心进行评估的比率、在等待名单上的位置和接受移植的数据。结果：根据专家意见的适当性标准，黑人患者比白人患者更不可能被评为合适的移植候选人（71名黑人[9.0%]对152名白人[20.9%]），并且更可能有不完整的评估(368名[46.5%]对282名[38.8%]，P
Background: Despite abundant evidence of racial disparities in the use of surgical procedures, it is uncertain whether these disparities reflect racial differences in clinical appropriateness or overuse or underuse of care.Methods: We performed a literature review and used an expert panel to develop criteria for determining the appropriateness of renal transplantation for patients with end-stage renal disease. Using data from five states and the District of Columbia on patients who had started to undergo dialysis in 1996 or 1997, we selected a random sample of 1518 patients (age range, 18 to 54 years), stratified according to race and sex. We classified the appropriateness of patients as candidates for transplantation and analyzed data on rates of referral to a transplantation center for evaluation, placement on a waiting list, and receipt of a transplant according to race.Results: Black patients were less likely than white patients to be rated as appropriate candidates for transplantation according to appropriateness criteria based on expert opinion (71 blacks [9.0 percent] vs. 152 whites [20.9 percent]) and were more likely to have had incomplete evaluations (368 [46.5 percent] vs. 282 [38.8 percent], P