Abstract: FR-PO1044
Examining Insurance-Related Disparities in Kidney Transplantation Access and Outcomes: A Systematic Review and Bibliometric Analysis
Session Information
- Social, Environmental, and Economic Determinants of Kidney Health
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Garcia Valencia, Oscar Alejandro, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Suppadungsuk, Supawadee, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Jadlowiec, Caroline, Mayo Clinic Arizona, Scottsdale, Arizona, United States
- Leeaphorn, Napat, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Budhiraja, Pooja, Mayo Clinic Arizona, Scottsdale, Arizona, United States
- Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Equitable access to kidney transplantation is vital for patients with end-stage kidney disease, however insurance and social determinants significantly affect access and outcomes. This study examines disparities in waitlisting, access, and post-transplant outcomes based on insurance types, focusing on promoting diversity and equity in kidney health.
Methods
This systematic review and bibliometric analysis from MEDLINE, EMBASE, and Cochrane Database searches up to November 2023, assessed the impact of insurance types on kidney transplantation disparities. The systematic review followed PRISMA guidelines, and the bibliometric analysis examined research trends, leading institutions, and citation impact.
Results
St. Louis University and Walter Reed Army Medical Center lead in publications and citation impact. A systematic review of 15 U.S. studies (2008-2023) revealed disparities in waitlisting and outcomes linked to insurance. Medicare beneficiaries have better survival rates. African Americans on Medicaid are less likely to be added to the waitlist. Public insurance holders have fewer preemptive transplants, heightened mortality and allograft failure rates. Alarmingly, over a quarter of transplant ethics consultations highlight insurance limitations affecting treatment. Those holding dual (private/public) insurance exhibit higher rates of medication nonadherence. Medicare's coverage expansion to include immunosuppressive drugs might help mitigate these disparities.
Conclusion
Our systematic review and bibliometric analysis reveal disparities in kidney transplant outcomes influenced by insurance and social factors. Public insurance holders, especially Medicare or Medicaid beneficiaries, face significant obstacles in transplant access and increased post-transplant risks. Addressing these disparities in kidney transplantation and recognizing the contributions of leading research institutions and investigators is crucial.