Rurality Status Does Not Affect Kidney Transplant (KTP) Rates Among Veterans Compared to Medicare, Medicaid, and Private Insurance (PrivIns) Beneficiaries.
1Internal Medicine/Nephrology, University of Iowa, Iowa City
2Comprehensive Access and Delivery Research Evaluation (CADRE), Iowa City VAMC, Iowa City.
Meeting: 2016 American Transplant Congress
Abstract number: B66
Keywords: Economics, Kidney transplantation, Medicare, Waiting lists
Session Information
Session Name: Poster Session B: Disparities in Access and Outcomes
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background: A larger proportion of Veterans live in rural areas compared to non-Veterans. It is unknown whether rural status affects KTP rates among Veterans.
Methods: Study cohort included KTPs in the US from 2000 to 2013 identified via UNOS and linked to VINCI (VA Informatics and Computing Infrastructure) database. Rates of KTP among patients receiving Medicare/Medicaid or PrivIns was compared to Veterans registered in 4 active VA KTP programs according to residential rurality status. Rates of KTP among VA patients were compared between rural and non-rural residents.
Results: 479,834 non-VA and 3,418 VA patients were registered for KTP during this period. VA candidates were older, and had a higher rate of diabetes (p<0.0001 for both). A comparison of VA vs non-VA candidates by rural status were as follows: Isolated (5.7% vs. 3.6%), Small Rural (5.9% vs. 4.4%), Large Rural (11.7 vs. 8.6%), (p<0.0001).
Among VA KTP candidates, no difference in overall KTP rates by rurality was determined, but a trend for higher rate of LD KTP among rural VA residents was observed. Duration of dialysis prior to registration was longer among VA urban residents (p=0.016), but time from WL to KTP was similar among rural and non-rural Veterans (p=0.155). Comparison of time on WL and KTP rates according to rural status within VA and non-VA beneficiaries are shown in Table 1.
| Variable | Isolated | Small Rural | Large Rural | Urban | Kruskal-Wallis p-value |
| Number of patients, non-VA | 15,664 | 20,547 | 38,558 | 395,576 | |
| Number of patients, VA | 172 | 175 | 346 | 2606 | |
| Time on dialysis (days) before listing, non-VA, mean (SEM) | 652 (6.74) | 693 (6.76) | 687 (4.65) | 722 (1.59) | 0.0035 |
| Time on dialysis before listing,VA | 671(65.3) | 625(53.9) | 703(35.9) | 805 (19.4) | 0.016 |
| Time on WL, non-VA, mean(SEM) | 550(4.4) | 565(3.97) | 568(2.9) | 629(1) | <0.0001 |
| Time on WL, VA | 519(38.6) | 725(48.8) | 615(27.9) | 662(19.4) | 0.15 |
| Transplant (%), non-VA | 48.5 | 46.7 | 46.4 | 42.9 | 0.335 |
| Transplant (%) , VA | 40 | 42.9 | 43.9 | 37.5 | 0.064 |
Conclusions: Higher rate of rural status of KTP candidates among VA beneficiaries does not portend longer waiting times or lower rates of kidney transplantation comparing to urban residents. Similar trend is observed in non-VA beneficiaries.
CITATION INFORMATION: Kalil R, Franciscus C, O'Shea A. Rurality Status Does Not Affect Kidney Transplant (KTP) Rates Among Veterans Compared to Medicare, Medicaid, and Private Insurance (PrivIns) Beneficiaries. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Kalil R, Franciscus C, O'Shea A. Rurality Status Does Not Affect Kidney Transplant (KTP) Rates Among Veterans Compared to Medicare, Medicaid, and Private Insurance (PrivIns) Beneficiaries. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/rurality-status-does-not-affect-kidney-transplant-ktp-rates-among-veterans-compared-to-medicare-medicaid-and-private-insurance-privins-beneficiaries/. Accessed May 31, 2025.« Back to 2016 American Transplant Congress