Access to renal transplantation among American Indians and Hispanics

Thomas D. Sequist, Andrew S. Narva, Sharon K. Stiles, Shelley K. Karp, Alan Cass, John Z. Ayanian

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: African Americans have decreased access to renal transplantation compared with whites. Whether similar barriers exist for American Indians or Hispanics is not well defined. 

Methods: The authors identified a total of 1,335 patients ages 20 to 59 years without prior renal transplantation undergoing dialysis in December 1994 in Arizona and New Mexico. For each patient, information was collected on identification as a potential candidate for renal transplantation, referral to a renal transplantation center, completion of 4 stages in the evaluation process, and receipt of a transplant over 7 years. 

Results: American Indians were more likely than whites to be identified as potential candidates (relative risk [RR] 1.30, 95% confidence interval [CI] 1.15 to 1.44) and to be referred to a transplant center (RR 1.16, 95% CI 1.09 to 1.19). There were no significant differences in candidacy or referral status between Hispanics and whites. Among potential candidates referred to a transplant center, both American Indians (RR 0.73, 95% CI 0.51 to 0.96) and Hispanics (RR 0.68, 95% CI 0.50 to 0.88) were less likely than whites to be placed on a waiting list. Both American Indians (hazard ratio [HR] 0.37, 95% CI 0.24 to 0.58) and Hispanics (HR 0.58, 95% CI 0.39 to 0.86) were much less likely than whites to undergo renal transplantation. 

Conclusion: Despite similar referral rates for renal transplantation, American Indians and Hispanics were less likely than whites to be placed on a transplant waiting list or receive a transplant. Policies to address these disparities should address specific barriers within the transplant evaluation process.

Original languageEnglish
Pages (from-to)344-352
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume44
Issue number2
DOIs
Publication statusPublished - Aug 2004
Externally publishedYes

Fingerprint

North American Indians
Hispanic Americans
Kidney Transplantation
Confidence Intervals
Transplants
Referral and Consultation
Waiting Lists
African Americans
Dialysis

Cite this

Sequist, Thomas D. ; Narva, Andrew S. ; Stiles, Sharon K. ; Karp, Shelley K. ; Cass, Alan ; Ayanian, John Z. / Access to renal transplantation among American Indians and Hispanics. In: American Journal of Kidney Diseases. 2004 ; Vol. 44, No. 2. pp. 344-352.
@article{85c728c0bdb04cd1916aea6f5fcf3312,
title = "Access to renal transplantation among American Indians and Hispanics",
abstract = "Background: African Americans have decreased access to renal transplantation compared with whites. Whether similar barriers exist for American Indians or Hispanics is not well defined. Methods: The authors identified a total of 1,335 patients ages 20 to 59 years without prior renal transplantation undergoing dialysis in December 1994 in Arizona and New Mexico. For each patient, information was collected on identification as a potential candidate for renal transplantation, referral to a renal transplantation center, completion of 4 stages in the evaluation process, and receipt of a transplant over 7 years. Results: American Indians were more likely than whites to be identified as potential candidates (relative risk [RR] 1.30, 95{\%} confidence interval [CI] 1.15 to 1.44) and to be referred to a transplant center (RR 1.16, 95{\%} CI 1.09 to 1.19). There were no significant differences in candidacy or referral status between Hispanics and whites. Among potential candidates referred to a transplant center, both American Indians (RR 0.73, 95{\%} CI 0.51 to 0.96) and Hispanics (RR 0.68, 95{\%} CI 0.50 to 0.88) were less likely than whites to be placed on a waiting list. Both American Indians (hazard ratio [HR] 0.37, 95{\%} CI 0.24 to 0.58) and Hispanics (HR 0.58, 95{\%} CI 0.39 to 0.86) were much less likely than whites to undergo renal transplantation. Conclusion: Despite similar referral rates for renal transplantation, American Indians and Hispanics were less likely than whites to be placed on a transplant waiting list or receive a transplant. Policies to address these disparities should address specific barriers within the transplant evaluation process.",
keywords = "American Indians, chronic kidney failure, Hispanics, Native Americans, renal transplantation, Southwestern United States",
author = "Sequist, {Thomas D.} and Narva, {Andrew S.} and Stiles, {Sharon K.} and Karp, {Shelley K.} and Alan Cass and Ayanian, {John Z.}",
year = "2004",
month = "8",
doi = "10.1053/j.ajkd.2004.04.039",
language = "English",
volume = "44",
pages = "344--352",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders",
number = "2",

}

Access to renal transplantation among American Indians and Hispanics. / Sequist, Thomas D.; Narva, Andrew S.; Stiles, Sharon K.; Karp, Shelley K.; Cass, Alan; Ayanian, John Z.

In: American Journal of Kidney Diseases, Vol. 44, No. 2, 08.2004, p. 344-352.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Access to renal transplantation among American Indians and Hispanics

AU - Sequist, Thomas D.

AU - Narva, Andrew S.

AU - Stiles, Sharon K.

AU - Karp, Shelley K.

AU - Cass, Alan

AU - Ayanian, John Z.

PY - 2004/8

Y1 - 2004/8

N2 - Background: African Americans have decreased access to renal transplantation compared with whites. Whether similar barriers exist for American Indians or Hispanics is not well defined. Methods: The authors identified a total of 1,335 patients ages 20 to 59 years without prior renal transplantation undergoing dialysis in December 1994 in Arizona and New Mexico. For each patient, information was collected on identification as a potential candidate for renal transplantation, referral to a renal transplantation center, completion of 4 stages in the evaluation process, and receipt of a transplant over 7 years. Results: American Indians were more likely than whites to be identified as potential candidates (relative risk [RR] 1.30, 95% confidence interval [CI] 1.15 to 1.44) and to be referred to a transplant center (RR 1.16, 95% CI 1.09 to 1.19). There were no significant differences in candidacy or referral status between Hispanics and whites. Among potential candidates referred to a transplant center, both American Indians (RR 0.73, 95% CI 0.51 to 0.96) and Hispanics (RR 0.68, 95% CI 0.50 to 0.88) were less likely than whites to be placed on a waiting list. Both American Indians (hazard ratio [HR] 0.37, 95% CI 0.24 to 0.58) and Hispanics (HR 0.58, 95% CI 0.39 to 0.86) were much less likely than whites to undergo renal transplantation. Conclusion: Despite similar referral rates for renal transplantation, American Indians and Hispanics were less likely than whites to be placed on a transplant waiting list or receive a transplant. Policies to address these disparities should address specific barriers within the transplant evaluation process.

AB - Background: African Americans have decreased access to renal transplantation compared with whites. Whether similar barriers exist for American Indians or Hispanics is not well defined. Methods: The authors identified a total of 1,335 patients ages 20 to 59 years without prior renal transplantation undergoing dialysis in December 1994 in Arizona and New Mexico. For each patient, information was collected on identification as a potential candidate for renal transplantation, referral to a renal transplantation center, completion of 4 stages in the evaluation process, and receipt of a transplant over 7 years. Results: American Indians were more likely than whites to be identified as potential candidates (relative risk [RR] 1.30, 95% confidence interval [CI] 1.15 to 1.44) and to be referred to a transplant center (RR 1.16, 95% CI 1.09 to 1.19). There were no significant differences in candidacy or referral status between Hispanics and whites. Among potential candidates referred to a transplant center, both American Indians (RR 0.73, 95% CI 0.51 to 0.96) and Hispanics (RR 0.68, 95% CI 0.50 to 0.88) were less likely than whites to be placed on a waiting list. Both American Indians (hazard ratio [HR] 0.37, 95% CI 0.24 to 0.58) and Hispanics (HR 0.58, 95% CI 0.39 to 0.86) were much less likely than whites to undergo renal transplantation. Conclusion: Despite similar referral rates for renal transplantation, American Indians and Hispanics were less likely than whites to be placed on a transplant waiting list or receive a transplant. Policies to address these disparities should address specific barriers within the transplant evaluation process.

KW - American Indians

KW - chronic kidney failure

KW - Hispanics

KW - Native Americans

KW - renal transplantation

KW - Southwestern United States

UR - http://www.scopus.com/inward/record.url?scp=3242699933&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2004.04.039

DO - 10.1053/j.ajkd.2004.04.039

M3 - Article

VL - 44

SP - 344

EP - 352

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 2

ER -