Black persons with end-stage renal disease (ESRD) who live in poorer neighborhoods are less likely to be placed on kidney transplant waiting lists than white persons within the same neighborhood poverty level, according to a study reported by Emory University researchers.
The study findings were presented this week at the annual meeting of the American Society of Nephrology in San Francisco.
"The findings warrant further exploration but suggest that racial disparity in the waitlisting process may indeed be a reflection of differential access to healthcare," says study co-author Sandra Amaral, MD, assistant professor of pediatrics, Emory University School of Medicine.
Dr. Amaral and her team analyzed the relationship between being placed on a transplant waiting list and distance from a patient's residence to the nearest transplant center among ESRD patients in Georgia and the Carolinas from 1998 to 2002. Waitlisting status was assessed using data from the United Network for Organ Sharing.
The researchers hypothesized that patients living farther from transplant centers would be less likely to be placed on the transplantation waiting list. However, distance to the transplant center did not significantly affect the chances of being waitlisted, they found. The patients lived an average of 49 miles from the nearest transplant facility.
In contrast, black patients living in poorer neighborhoods -- based on U.S. Census data -- were less likely to be placed on the waiting list than whites patients in the same neighborhoods. There appeared to be no significant racial difference in waitlisting in higher-income neighborhoods.
"Black patients were 56 percent less likely than white patients to be waitlisted for transplantation in the most impoverished neighborhoods," Dr. Amaral says.
Of the 12,572 ESRD patients in the study, 17 percent were placed on the waiting list for a kidney transplant. Sixty-two percent of the ESRD patients were black, while 17 percent lived in impoverished neighborhoods.
Compared to non-Hispanic whites, blacks were more likely to live in high-poverty areas: 27 percent of black patients (versus 9 percent of whites) resided in areas with greater than 25 percent of the population living below the poverty line. Forty-four percent of the patients had diabetes-related ESRD, and 70 percent had other medical problems besides kidney disease. Other characteristics affecting the chances of being put on the waiting list included sex, age, body mass index and baseline clinical parameters, such as presence of anemia or hypoalbuminemia.
"Racial disparities persist in the U.S. transplantation process," notes Dr. Amaral. "The reasons for this are poorly understood, but multiple factors are likely involved."
The new results show that distance from transplant centers does not affect the likelihood of being waitlisted or explain racial disparity in the waitlisting process. However, community poverty does appear to be a significant factor.
"To our knowledge, this is the first study to examine the impact of community poverty on racial disparity in transplant waitlisting," says Dr. Amaral. "It also introduces a potential new approach to addressing the disparities -- reaching out to poorer communities with advocacy and education."