Controlling for Socioeconomic Barriers Reduces Racial Disparities in Transplant Pursuit
1David Geffen School of Medicine, UCLA, Los Angeles, CA
2University of Rhode Island, Kingston, RI
3Missouri Kidney Program, Columbia, MO.
Meeting: 2015 American Transplant Congress
Abstract number: C27
Keywords: African-American, Employment, Kidney transplantation, Patient education
Session Information
Session Name: Poster Session C: Disparities in Healthcare Access
Session Type: Poster Session
Date: Monday, May 4, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Compared to White dialysis patients, Black patients experience more socioeconomic barriers (SEBs) including higher financial insecurity and worse health insurance. To examine how SEBs affect pursuing transplant evaluation, in combination with other decision-making factors, we compared Black and White dialysis patients' levels of SEBs and examined factors associated with beginning transplant evaluation.
In 2014, we surveyed 317 dialysis patients in California and Missouri about their transplant knowledge, perceived pros/cons to transplant, SEBs and pursuit of transplant evaluation. Comparisons of SEBs by race and having begun transplant evaluation were made with chi-square tests. Multivariable logistic regression was used to compare the impacts of SEBs, decision-making variables, and race on pursuit of evaluation.
SEBs were more common among Black patients and those not beginning evaluation. Univariately, Black patients were less likely to have begun evaluation (Odds ratio: 1.66; 95% CI: 1.02-2.71). However, after accounting for SEBs and decision-making, this racial disparity did not persist. In multivariable analysis, not having private insurance (2.75; 95% CI: 1.43-5.30), having lower perceived pros to deceased donation (2.43; 95% CI: 1.48-3.99), lower transplant knowledge (2.06; 1.23-3.43), severe financial insecurity (2.02; 95% CI: 1.22-3.35), and higher perceived cons to living donation (1.73; 1.06-2.84) predicted not beginning evaluation instead.
| Black (n=221) | White (n=96) | p-value | Not begun evaluation (n=151) | Begun evaluation (n=163) | p-value | |
| No private insurance | 87% | 70% | <.001 | 89% | 74% | <.001 |
| Severe financial insecurity | 63% | 66% | .60 | 72% | 54% | .001 |
| High school education or less | 54% | 29% | .006 | 56% | 43% | .007 |
| No access to a vehicle | 44% | 18% | <.001 | 41% | 30% | .05 |
| Feels unsafe in home/neighborhood | 32% | 20% | .03 | 29% | 27% | .63 |
| Does not get required level of social support | 25% | 14% | .03 | 23% | 20% | .44 |
As these barriers are potentially modifiable, socioeconomic and educational interventions that provide financial assistance to overcome SEBs, increase dialysis patients' knowledge about the benefits of transplant, and reduce fears about transplant may reduce racial disparities in transplant pursuit.
To cite this abstract in AMA style:
Waterman A, Peipert J, Kynard-Amerson C, McSorley A-M, Paiva A, Robbins M, Peace L. Controlling for Socioeconomic Barriers Reduces Racial Disparities in Transplant Pursuit [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/controlling-for-socioeconomic-barriers-reduces-racial-disparities-in-transplant-pursuit/. Accessed May 19, 2025.« Back to 2015 American Transplant Congress