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- Title
Neighborhood Segregation and Access to Live Donor Kidney Transplantation.
- Authors
Li, Yiting; Menon, Gayathri; Kim, Byoungjun; Bae, Sunjae; Quint, Evelien E.; Clark-Cutaia, Maya N.; Wu, Wenbo; Thompson, Valerie L.; Crews, Deidra C.; Purnell, Tanjala S.; Thorpe Jr, Roland J.; Szanton, Sarah L.; Segev, Dorry L.; McAdams DeMarco, Mara A.
- Abstract
Key Points: Question: Is racial and ethnic segregation in the residential and transplant center neighborhood associated with access to live donor kidney transplantation (LDKT) for candidates? Findings: In this national cohort study of 162 587 candidates, Black candidates who resided in or were listed at a transplant center located in a high-segregation neighborhood had 10% and 6% lower access to LDKT, respectively, compared with Black candidates in low-segregation neighborhoods. Meaning: Segregation at the residential and transplant center neighborhoods may be a key mechanism driving racial inequalities; to address racial disparities in LDKT access, it is crucial to identify interventions that can be targeted at the community and health care levels. Importance: Identifying the mechanisms of structural racism, such as racial and ethnic segregation, is a crucial first step in addressing the persistent disparities in access to live donor kidney transplantation (LDKT). Objective: To assess whether segregation at the candidate's residential neighborhood and transplant center neighborhood is associated with access to LDKT. Design, Setting, and Participants: In this cohort study spanning January 1995 to December 2021, participants included non-Hispanic Black or White adult candidates for first-time LDKT reported in the US national transplant registry. The median (IQR) follow-up time for each participant was 1.9 (0.6-3.0) years. Main Outcome and Measures: Segregation, measured using the Theil H method to calculate segregation tertiles in zip code tabulation areas based on the American Community Survey 5-year estimates, reflects the heterogeneity in neighborhood racial and ethnic composition. To quantify the likelihood of LDKT by neighborhood segregation, cause-specific hazard models were adjusted for individual-level and neighborhood-level factors and included an interaction between segregation tertiles and race. Results: Among 162 587 candidates for kidney transplant, the mean (SD) age was 51.6 (13.2) years, 65 141 (40.1%) were female, 80 023 (49.2%) were Black, and 82 564 (50.8%) were White. Among Black candidates, living in a high-segregation neighborhood was associated with 10% (adjusted hazard ratio [AHR], 0.90 [95% CI, 0.84-0.97]) lower access to LDKT relative to residence in low-segregation neighborhoods; no such association was observed among White candidates (P for interaction =.01). Both Black candidates (AHR, 0.94 [95% CI, 0.89-1.00]) and White candidates (AHR, 0.92 [95% CI, 0.88-0.97]) listed at transplant centers in high-segregation neighborhoods had lower access to LDKT relative to their counterparts listed at centers in low-segregation neighborhoods (P for interaction =.64). Within high-segregation transplant center neighborhoods, candidates listed at predominantly minority neighborhoods had 17% lower access to LDKT relative to candidates listed at predominantly White neighborhoods (AHR, 0.83 [95% CI, 0.75-0.92]). Black candidates residing in or listed at transplant centers in predominantly minority neighborhoods had significantly lower likelihood of LDKT relative to White candidates residing in or listed at transplant centers located in predominantly White neighborhoods (65% and 64%, respectively). Conclusions: Segregated residential and transplant center neighborhoods likely serve as a mechanism of structural racism, contributing to persistent racial disparities in access to LDKT. To promote equitable access, studies should assess targeted interventions (eg, community outreach clinics) to improve support for potential candidates and donors and ultimately mitigate the effects of segregation. This cohort study assesses how neighborhood segregation is associated with racial disparities in access to live donor kidney transplantation, examining both the candidates' residential and transplant center neighborhoods.
- Publication
JAMA Internal Medicine, 2024, Vol 184, Issue 4, p402
- ISSN
2168-6106
- Publication type
Article
- DOI
10.1001/jamainternmed.2023.8184