Access to renal transplantation for minority patients with ESRD in Canada

Karen E. Yeates, Douglas E. Schaubel, Alan Cass, Thomas D. Sequist, John Z. Ayanian

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The incidence of end-stage renal disease is increasing worldwide. Renal transplantation generally is the preferred modality of renal replacement therapy; however, in the United States, it is known that minority groups experience decreased access to renal transplantation. It is unknown whether similar differences exist in Canada. 

Methods: Using the Canadian Organ Replacement Register, we identified 25,632 Canadian patients 18 years or older initiating renal replacement therapy during 1990 to 1998. We used Cox regression models to examine adjusted renal transplantation rates among whites, aboriginals, blacks, South Asians, and East Indians during an 8-year period. 

Results: Adjusted overall transplantation rates were decreased in comparison to whites for aboriginals (rate ratio [RR], 0.54; 95% confidence interval, 0.45 to 0.63), blacks (RR, 0.54; 95% confidence interval, 0.46 to 0.66), South Asians (RR, 0.69; 95% confidence interval, 0.61 to 0.79), and East Indians (RR, 0.66; 95% confidence interval, 0.56 to 0.78). Race was at least as strong a predictor of transplantation as other known predictors, including age, sex, primary renal diagnosis, and comorbidities. Disparities in renal transplantation rates increased over time from 1990 to 1998 for all racial groups in comparison to whites. 

Conclusion: Renal transplantation rates differ substantially by race in Canada, and these differences appear to be worsening over time. Future work should focus on identifying the specific barriers responsible for these differences in care.

Original languageEnglish
Pages (from-to)1083-1089
Number of pages7
JournalAmerican Journal of Kidney Diseases
Volume44
Issue number6
DOIs
Publication statusPublished - Dec 2004
Externally publishedYes

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Kidney Transplantation
Chronic Kidney Failure
Canada
Confidence Intervals
Renal Replacement Therapy
Transplantation
Minority Groups
Proportional Hazards Models
Comorbidity
Kidney
Incidence

Cite this

Yeates, Karen E. ; Schaubel, Douglas E. ; Cass, Alan ; Sequist, Thomas D. ; Ayanian, John Z. / Access to renal transplantation for minority patients with ESRD in Canada. In: American Journal of Kidney Diseases. 2004 ; Vol. 44, No. 6. pp. 1083-1089.
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abstract = "Background: The incidence of end-stage renal disease is increasing worldwide. Renal transplantation generally is the preferred modality of renal replacement therapy; however, in the United States, it is known that minority groups experience decreased access to renal transplantation. It is unknown whether similar differences exist in Canada. Methods: Using the Canadian Organ Replacement Register, we identified 25,632 Canadian patients 18 years or older initiating renal replacement therapy during 1990 to 1998. We used Cox regression models to examine adjusted renal transplantation rates among whites, aboriginals, blacks, South Asians, and East Indians during an 8-year period. Results: Adjusted overall transplantation rates were decreased in comparison to whites for aboriginals (rate ratio [RR], 0.54; 95{\%} confidence interval, 0.45 to 0.63), blacks (RR, 0.54; 95{\%} confidence interval, 0.46 to 0.66), South Asians (RR, 0.69; 95{\%} confidence interval, 0.61 to 0.79), and East Indians (RR, 0.66; 95{\%} confidence interval, 0.56 to 0.78). Race was at least as strong a predictor of transplantation as other known predictors, including age, sex, primary renal diagnosis, and comorbidities. Disparities in renal transplantation rates increased over time from 1990 to 1998 for all racial groups in comparison to whites. Conclusion: Renal transplantation rates differ substantially by race in Canada, and these differences appear to be worsening over time. Future work should focus on identifying the specific barriers responsible for these differences in care.",
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Access to renal transplantation for minority patients with ESRD in Canada. / Yeates, Karen E.; Schaubel, Douglas E.; Cass, Alan; Sequist, Thomas D.; Ayanian, John Z.

In: American Journal of Kidney Diseases, Vol. 44, No. 6, 12.2004, p. 1083-1089.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Access to renal transplantation for minority patients with ESRD in Canada

AU - Yeates, Karen E.

AU - Schaubel, Douglas E.

AU - Cass, Alan

AU - Sequist, Thomas D.

AU - Ayanian, John Z.

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N2 - Background: The incidence of end-stage renal disease is increasing worldwide. Renal transplantation generally is the preferred modality of renal replacement therapy; however, in the United States, it is known that minority groups experience decreased access to renal transplantation. It is unknown whether similar differences exist in Canada. Methods: Using the Canadian Organ Replacement Register, we identified 25,632 Canadian patients 18 years or older initiating renal replacement therapy during 1990 to 1998. We used Cox regression models to examine adjusted renal transplantation rates among whites, aboriginals, blacks, South Asians, and East Indians during an 8-year period. Results: Adjusted overall transplantation rates were decreased in comparison to whites for aboriginals (rate ratio [RR], 0.54; 95% confidence interval, 0.45 to 0.63), blacks (RR, 0.54; 95% confidence interval, 0.46 to 0.66), South Asians (RR, 0.69; 95% confidence interval, 0.61 to 0.79), and East Indians (RR, 0.66; 95% confidence interval, 0.56 to 0.78). Race was at least as strong a predictor of transplantation as other known predictors, including age, sex, primary renal diagnosis, and comorbidities. Disparities in renal transplantation rates increased over time from 1990 to 1998 for all racial groups in comparison to whites. Conclusion: Renal transplantation rates differ substantially by race in Canada, and these differences appear to be worsening over time. Future work should focus on identifying the specific barriers responsible for these differences in care.

AB - Background: The incidence of end-stage renal disease is increasing worldwide. Renal transplantation generally is the preferred modality of renal replacement therapy; however, in the United States, it is known that minority groups experience decreased access to renal transplantation. It is unknown whether similar differences exist in Canada. Methods: Using the Canadian Organ Replacement Register, we identified 25,632 Canadian patients 18 years or older initiating renal replacement therapy during 1990 to 1998. We used Cox regression models to examine adjusted renal transplantation rates among whites, aboriginals, blacks, South Asians, and East Indians during an 8-year period. Results: Adjusted overall transplantation rates were decreased in comparison to whites for aboriginals (rate ratio [RR], 0.54; 95% confidence interval, 0.45 to 0.63), blacks (RR, 0.54; 95% confidence interval, 0.46 to 0.66), South Asians (RR, 0.69; 95% confidence interval, 0.61 to 0.79), and East Indians (RR, 0.66; 95% confidence interval, 0.56 to 0.78). Race was at least as strong a predictor of transplantation as other known predictors, including age, sex, primary renal diagnosis, and comorbidities. Disparities in renal transplantation rates increased over time from 1990 to 1998 for all racial groups in comparison to whites. Conclusion: Renal transplantation rates differ substantially by race in Canada, and these differences appear to be worsening over time. Future work should focus on identifying the specific barriers responsible for these differences in care.

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