Sex/Gender Disparities in Preemptive Referrals for Kidney Transplantation
Introduction: Sex/gender inequities persist in access to kidney transplantation. Whether differences in preemptive referral (i.e., referral before dialysis start) explain this inequity remains unknown. Methods: All adults (aged 18–79 years; N = 44,204) initiating kidney replacement therapy (KRT; dia...
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Elsevier
2024-07-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024924016486 |
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| author | Jessica L. Harding Annika Gompers Mengyu Di Kelsey Drewery Stephen Pastan Ana Rossi Derek DuBay Jennifer C. Gander Rachel E. Patzer |
| author_facet | Jessica L. Harding Annika Gompers Mengyu Di Kelsey Drewery Stephen Pastan Ana Rossi Derek DuBay Jennifer C. Gander Rachel E. Patzer |
| author_sort | Jessica L. Harding |
| collection | DOAJ |
| description | Introduction: Sex/gender inequities persist in access to kidney transplantation. Whether differences in preemptive referral (i.e., referral before dialysis start) explain this inequity remains unknown. Methods: All adults (aged 18–79 years; N = 44,204) initiating kidney replacement therapy (KRT; dialysis or transplant) in Georgia (GA), North Carolina (NC), or South Carolina (SC) between 2015 and 2019 were identified from the United States Renal Data System (USRDS). Individuals were linked to the Early Steps to Kidney Transplant Access Registry (E-STAR) to obtain data on preemptive referral and followed-up with through November 13, 2020, for outcomes of waitlisting and living donor transplant. Logistic regression assessed the association between sex/gender and likelihood of preemptive referral among all KRT patients. Cox-proportional hazards assessed the association between sex/gender and waitlisting or living donor among preemptively referred patients. Results: Overall, men and women were similarly likely to be preemptively referred (odds ratio [OR]: 0.99 [0.95–1.04]). Preemptively referred women (vs. men) were, on average, younger and with fewer comorbidities. There were no sex/gender differences in waitlisting once patients were preemptively referred (hazard ratio [HR]: 0.97 [0.91–1.03]); however, women (vs. men) who were preemptively referred remained 25% (HR: 0.75 [0.66–0.86]) less likely to receive a living donor transplant. Conclusion: In the Southeast US, men and women initiating KRT are similarly likely to be preemptively referred for a kidney transplant, and this appears, at least in part, to mitigate known sex/gender inequities in access to waitlisting, but not living donor transplant. Despite this, preemptively referred women, on average, had a more favorable medical profile relative to preemptively referred men. |
| format | Article |
| id | doaj-art-65faedf640ff4f68a426c80668b76314 |
| institution | DOAJ |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-65faedf640ff4f68a426c80668b763142025-08-20T03:21:11ZengElsevierKidney International Reports2468-02492024-07-01972134214510.1016/j.ekir.2024.04.025Sex/Gender Disparities in Preemptive Referrals for Kidney TransplantationJessica L. Harding0Annika Gompers1Mengyu Di2Kelsey Drewery3Stephen Pastan4Ana Rossi5Derek DuBay6Jennifer C. Gander7Rachel E. Patzer8Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA; Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA; Correspondence: Jessica L. Harding, Department of Epidemiology, Rollins School of Public Health, Emory University, 101 Woodruff Circle, Woodruff Research Memorial Building, Suite 1019, Atlanta, Georgia 30322, USA.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USAWilliam M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USADepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA; Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA; William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA; Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA; Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA; Piedmont Transplant Institute, Atlanta, Georgia, USA; Prisma Healthcare, Charleston, South Carolina, USA; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia, USADepartment of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USAPiedmont Transplant Institute, Atlanta, Georgia, USAPrisma Healthcare, Charleston, South Carolina, USACenter for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia, USADepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA; Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA; William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA; Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA; Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA; Piedmont Transplant Institute, Atlanta, Georgia, USA; Prisma Healthcare, Charleston, South Carolina, USA; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia, USAIntroduction: Sex/gender inequities persist in access to kidney transplantation. Whether differences in preemptive referral (i.e., referral before dialysis start) explain this inequity remains unknown. Methods: All adults (aged 18–79 years; N = 44,204) initiating kidney replacement therapy (KRT; dialysis or transplant) in Georgia (GA), North Carolina (NC), or South Carolina (SC) between 2015 and 2019 were identified from the United States Renal Data System (USRDS). Individuals were linked to the Early Steps to Kidney Transplant Access Registry (E-STAR) to obtain data on preemptive referral and followed-up with through November 13, 2020, for outcomes of waitlisting and living donor transplant. Logistic regression assessed the association between sex/gender and likelihood of preemptive referral among all KRT patients. Cox-proportional hazards assessed the association between sex/gender and waitlisting or living donor among preemptively referred patients. Results: Overall, men and women were similarly likely to be preemptively referred (odds ratio [OR]: 0.99 [0.95–1.04]). Preemptively referred women (vs. men) were, on average, younger and with fewer comorbidities. There were no sex/gender differences in waitlisting once patients were preemptively referred (hazard ratio [HR]: 0.97 [0.91–1.03]); however, women (vs. men) who were preemptively referred remained 25% (HR: 0.75 [0.66–0.86]) less likely to receive a living donor transplant. Conclusion: In the Southeast US, men and women initiating KRT are similarly likely to be preemptively referred for a kidney transplant, and this appears, at least in part, to mitigate known sex/gender inequities in access to waitlisting, but not living donor transplant. Despite this, preemptively referred women, on average, had a more favorable medical profile relative to preemptively referred men.http://www.sciencedirect.com/science/article/pii/S2468024924016486epidemiologygender disparitieshealth services researchkidney transplanttransplant referral |
| spellingShingle | Jessica L. Harding Annika Gompers Mengyu Di Kelsey Drewery Stephen Pastan Ana Rossi Derek DuBay Jennifer C. Gander Rachel E. Patzer Sex/Gender Disparities in Preemptive Referrals for Kidney Transplantation Kidney International Reports epidemiology gender disparities health services research kidney transplant transplant referral |
| title | Sex/Gender Disparities in Preemptive Referrals for Kidney Transplantation |
| title_full | Sex/Gender Disparities in Preemptive Referrals for Kidney Transplantation |
| title_fullStr | Sex/Gender Disparities in Preemptive Referrals for Kidney Transplantation |
| title_full_unstemmed | Sex/Gender Disparities in Preemptive Referrals for Kidney Transplantation |
| title_short | Sex/Gender Disparities in Preemptive Referrals for Kidney Transplantation |
| title_sort | sex gender disparities in preemptive referrals for kidney transplantation |
| topic | epidemiology gender disparities health services research kidney transplant transplant referral |
| url | http://www.sciencedirect.com/science/article/pii/S2468024924016486 |
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