The Effect Of Structural Racism On Racial And Geographic Disparities In Deceased Organ Donation

结构性种族主义对死者器官捐赠种族和地理差异的影响

• 批准号: 10537133
• 负责人: Lawrence Brown
• 金额: $ 8.58万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-14 至 2025-07-13
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10537133
• 关键词: Accident and Emergency department; Address; Affect; Benchmarking; Big Data; Black Populations; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Clinical; County; Data; Data Linkages; Data Set; Databases; Disadvantaged minority; Doctor of Philosophy; Educational Status; Enrollment; Face; Faculty; Frequencies; Geography; Goals; Health; Health Disparities Research; Health Policy; Health care facility; Healthcare; Home; Hospitalization; Hospitals; Individual; Inpatients; Instruction; International; Intervention; Knowledge; Legal; Location; Long-Term Care; Mediating; Mediator of activation protein; Medical; Mentors; Mentorship; Methods; Midwestern United States; Minority; Minority Groups; National Health and Nutrition Examination Survey; Neighborhoods; Operative Surgical Procedures; Organ; Organ Donations; Organ Donor; Organ Transplantation; Outcome; Outpatients; Policies; Population; Proxy; Public Health; Public Health Schools; Race; Recovery; Registries; Research; Research Project Grants; Resources; Risk Factors; Scientist; Source; Statistical Computing; Statistical Models; Structural Racism; Surgeon; Time; Training; Transplant Recipients; Transplantation; Wait Time; Waiting Lists; Work; certificate program; clinical investigation; data management; density; deprivation; geographic difference; geographic disparity; health care availability; health care service utilization; health disparity; health inequalities; mortality; multilevel analysis; novel; organ allocation; programs; racial determinant; racial difference; racial disparity; racial health disparity; racial minority; racism; residential segregation; rurality; segregation; social determinants; social epidemiology; statistical learning; transplant registry

PROJECT SUMMARY/ABSTRACT Among the 12,000 deceased organ donors yearly in the US, there are racial disparities that have persisted over decades, with the Black population most recently donating at 69% of the White population. Relatively lower organ donation rates among racial minorities not only contribute to the organ shortage but also contribute to racial disparities in waitlisted candidate’s access to transplantation, with some racial minorities having longer wait times owing to difficult matching. Historically, efforts to address racial disparities in deceased organ donation have examined inpatient medical facility deaths, using inpatient death counts to estimate the potential organ donor pool, to benchmark successful organ recovery, and to target interventions. While only individuals who die in an inpatient medical facility can have their organs recovered for transplantation, the focus on this highly selected population is limiting. Structural racism, a determinant of racial disparities in health, affects healthcare resource availability, with Black individuals being 40% less likely than White individuals to have a usual source of healthcare in racially segregated neighborhoods. To date, healthcare resource availability has not been examined as a potential mediator of racial and geographic disparities in deceased organ donation. To better understand the impact of structural racism on deceased donor rates, we will perform novel linkages with three nationally representative datasets (Scientific Registry of Transplant Recipients, CDC WONDER, and National Health and Nutrition Examination Survey) to study the following aims: (1) To examine county-level risk factors for inpatient and outpatient death under medical conditions consistent with organ donation; (2) To examine the relationship between structural racism and the potential organ donor rate; and (3) To examine whether healthcare access mediates the relationship between structural racism and the potential organ donor rate. We hypothesize that structural racism affects inpatient facility death distribution, and subsequent organ donation rates, through its differential effects on healthcare access according to race and across geographies. If the proposed aims are achieved, we will directly inform national healthcare access and organ allocation policy, and population-level structural interventions to eliminate racial disparities in transplantation.

项目摘要/摘要 在美国每年12000名已故器官捐赠者中，种族差异一直存在 几十年来，黑人人口的捐赠率达到了白人人口的69%。相对的 少数族裔中较低的器官捐赠率不仅是造成器官短缺的原因之一，也是 在等待名单的候选人获得移植方面的种族差异，一些少数族裔的时间更长 由于匹配困难，等待时间。 从历史上看，解决已故器官捐赠方面的种族差异的努力曾审查过住院患者的医疗 设施死亡，使用住院死亡计数来估计潜在的器官捐赠者池，以作为基准 成功地恢复器官，并有针对性地进行干预。而只有在住院医疗中死亡的人 可以将他们的器官回收用于移植，重点是这一高度挑选的人群 限制。结构性种族主义是健康方面种族差异的决定因素，影响医疗资源的可获得性， 黑人比白人拥有普通医疗保健来源的可能性低40% 种族隔离的社区。到目前为止，医疗保健资源的可用性还没有作为 死亡器官捐赠中种族和地理差异的潜在调解人。 为了更好地了解结构性种族主义对已故捐赠率的影响，我们将进行新的联系 拥有三个具有全国代表性的数据集(移植受者科学登记、CDC WONDER和 全国健康和营养检查调查)，以研究以下目的：(1)检查县级风险 在符合器官捐献的医疗条件下住院和门诊死亡的因素； 审查结构性种族主义与潜在器官捐赠率之间的关系；以及(3)审查 医疗服务的可获得性是否会调节结构性种族主义和潜在器官捐赠者之间的关系 费率。 我们假设结构性种族主义影响住院设施的死亡分布，以及随后的器官 捐赠率，通过其对不同种族和不同地理位置的医疗保健服务的不同影响。 如果建议的目标实现，我们将直接通知国家医疗保健获取和器官分配 政策，以及人口层面的结构性干预措施，以消除移植方面的种族差异。