Kidney Week

Abstract: FR-PO873

Relationship Between Driving Time to Transplant Center and Socioeconomic Factors With Early Waitlisting Among Transplant-Referred ESKD Patients

Session Information

• Diversity and Equity in Kidney Health - II
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 800 Diversity and Equity in Kidney Health

Authors

• Karpinski, Steph, Davita Clinical Research, Minneapolis, Minnesota, United States

Steph Karpinski,

• Colson, Carey, Davita Clinical Research, Minneapolis, Minnesota, United States

Carey Colson,

• Walker, Adam G., Davita Clinical Research, Minneapolis, Minnesota, United States

Adam G. Walker,

• Sibbel, Scott, Davita Clinical Research, Minneapolis, Minnesota, United States

Scott Sibbel,

• O'Shea, Michael H., DaVita Inc, Denver, Colorado, United States

Michael H. O'Shea,

• Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States

Francesca Tentori,

• Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States

Steven M. Brunelli,

Background

Understanding factors contributing to disparities in kidney transplantation in end-stage kidney disease patients is important. Placement on a transplant waitlist is an important gate-keeping step where disparities have been observed. In this study, we sought to estimate the independent effect of driving time to the transplant center on the probability of waitlisting.

Methods

This was a retrospective study of 33,158 adult incident dialysis patients in the United States referred for transplant. Bayesian methods were used to model the relationship between driving time from the patient’s home to the nearest transplant center and placement on a waitlist within 90 days of referral. We adjusted for causally relevant socioeconomic factors including educational encounters documented by the dialysis organization and US Census Bureau tract income and education data. We simulated observations based on relative levels of socioeconomic advantage (disadvantage and advantage comprising the 25^th and 75^th percentiles for listed variables, respectively).

Results

Overall, 2.0% of patients were waitlisted within 90 days of referral. The median [interquartile range] for driving time was 27 [14, 65] minutes. There was a non-linear relationship between driving time and probability of waitlisting (left Figure). This non-linear relationship interacts with the level of socioeconomic advantage to vary the slope (right Figure). A sensitivity analysis adjusting for race did not improve model fit.

Conclusion

Among the socioeconomically disadvantaged, there was an inverse relationship between driving time and the likelihood of early waitlisting. For those at higher socioeconomic advantage, early waitlisting was most likely for those living 20-30 minutes from a transplant center and did not vary much otherwise.

In right panel, purple vertical lines represent the 25^th, 50^th, and 75^th precentiles of driving time. Probability of waitlisting was reliably higher among advantaged patients compared to disadvantaged patients at each of these precentiles.