Has the department of veterans affairs found a way to avoid racial disparities in the evaluation process for kidney transplantation?

Michael Freeman, John R. Pleis, Kellee R. Bornemann, Emilee Croswell, Mary Amanda Dew, Chung Chou H. Chang, Galen E. Switzer, Anthony Langone, Anuja Mittal-Henkle, Somnath Saha, Mohan Ramkumar, Jareen Adams Flohr, Christie P. Thomas, Larissa Myaskovsky

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background. Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. Methods.We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. Results. There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ2 = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66- 0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. Conclusions. Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.

Original languageEnglish (US)
Pages (from-to)1191-1199
Number of pages9
JournalTransplantation
Volume101
Issue number6
DOIs
StatePublished - 2017

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Veterans
Kidney Transplantation
Transplants
Confidence Intervals
Minority Groups
Living Donors
Insurance
Longitudinal Studies
Comorbidity
Cohort Studies
Demography
Databases
Interviews

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Freeman, Michael ; Pleis, John R. ; Bornemann, Kellee R. ; Croswell, Emilee ; Dew, Mary Amanda ; Chang, Chung Chou H. ; Switzer, Galen E. ; Langone, Anthony ; Mittal-Henkle, Anuja ; Saha, Somnath ; Ramkumar, Mohan ; Flohr, Jareen Adams ; Thomas, Christie P. ; Myaskovsky, Larissa. / Has the department of veterans affairs found a way to avoid racial disparities in the evaluation process for kidney transplantation?. In: Transplantation. 2017 ; Vol. 101, No. 6. pp. 1191-1199.
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title = "Has the department of veterans affairs found a way to avoid racial disparities in the evaluation process for kidney transplantation?",
abstract = "Background. Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. Methods.We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. Results. There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ2 = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95{\%} confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95{\%} CI, 0.84-0.95), being married (HR, 0.81; 95{\%} CI, 0.66- 0.99), having private and public insurance (HR, 1.29; 95{\%} CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95{\%} CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. Conclusions. Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.",
author = "Michael Freeman and Pleis, {John R.} and Bornemann, {Kellee R.} and Emilee Croswell and Dew, {Mary Amanda} and Chang, {Chung Chou H.} and Switzer, {Galen E.} and Anthony Langone and Anuja Mittal-Henkle and Somnath Saha and Mohan Ramkumar and Flohr, {Jareen Adams} and Thomas, {Christie P.} and Larissa Myaskovsky",
year = "2017",
doi = "10.1097/TP.0000000000001377",
language = "English (US)",
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journal = "Transplantation",
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Freeman, M, Pleis, JR, Bornemann, KR, Croswell, E, Dew, MA, Chang, CCH, Switzer, GE, Langone, A, Mittal-Henkle, A, Saha, S, Ramkumar, M, Flohr, JA, Thomas, CP & Myaskovsky, L 2017, 'Has the department of veterans affairs found a way to avoid racial disparities in the evaluation process for kidney transplantation?', Transplantation, vol. 101, no. 6, pp. 1191-1199. https://doi.org/10.1097/TP.0000000000001377

Has the department of veterans affairs found a way to avoid racial disparities in the evaluation process for kidney transplantation? / Freeman, Michael; Pleis, John R.; Bornemann, Kellee R.; Croswell, Emilee; Dew, Mary Amanda; Chang, Chung Chou H.; Switzer, Galen E.; Langone, Anthony; Mittal-Henkle, Anuja; Saha, Somnath; Ramkumar, Mohan; Flohr, Jareen Adams; Thomas, Christie P.; Myaskovsky, Larissa.

In: Transplantation, Vol. 101, No. 6, 2017, p. 1191-1199.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Has the department of veterans affairs found a way to avoid racial disparities in the evaluation process for kidney transplantation?

AU - Freeman, Michael

AU - Pleis, John R.

AU - Bornemann, Kellee R.

AU - Croswell, Emilee

AU - Dew, Mary Amanda

AU - Chang, Chung Chou H.

AU - Switzer, Galen E.

AU - Langone, Anthony

AU - Mittal-Henkle, Anuja

AU - Saha, Somnath

AU - Ramkumar, Mohan

AU - Flohr, Jareen Adams

AU - Thomas, Christie P.

AU - Myaskovsky, Larissa

PY - 2017

Y1 - 2017

N2 - Background. Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. Methods.We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. Results. There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ2 = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66- 0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. Conclusions. Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.

AB - Background. Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. Methods.We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. Results. There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ2 = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66- 0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. Conclusions. Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.

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