Kidney Week

Abstract: TH-PO868

Medical Mistrust Predicts Lower Likelihood of Wait-Listing in Kidney Transplant Candidates

Session Information

• Race, Ethnicity, and Gender in Kidney Health and Care
  October 24, 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

• Velez-Bermudez, Miriam E., University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Miriam E. Velez-Bermudez, PhD

• Leyva, Yuridia, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Yuridia Leyva, MS

• Puttarajappa, Chethan M., UPMC, Pittsburgh, Pennsylvania, United States

Chethan M. Puttarajappa, MD, MS

• Kalaria, Arjun Lalit, UPMC, Pittsburgh, Pennsylvania, United States

Arjun Lalit Kalaria, MD

• Zhu, Yiliang, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Yiliang Zhu, PhD

• Ng, Yue-Harn, University of Washington School of Medicine, Seattle, Washington, United States

Yue-Harn Ng, MD, MPH

• Tevar, Amit D., UPMC, Pittsburgh, Pennsylvania, United States

Amit D. Tevar, MD

• Dew, Mary Amanda, UPMC, Pittsburgh, Pennsylvania, United States

Mary Amanda Dew, PhD

• Myaskovsky, Larissa, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Larissa Myaskovsky, PhD

Background

The kidney transplant fast track (KTFT) program was implemented within a large, single-center urban transplant center to reduce patient burden and streamline the kidney transplant (KT) evaluation process. KTFT aimed to improve the KT evaluation process for all patients, regardless of socioeconomic resources, and reduce the waitlisting disparity between White and Black patients. In this prospective cohort study of patients who underwent KTFT, we examined whether sociocultural factors (e.g., medical mistrust; discrimination & racism in healthcare; trust in physician) predicted the likelihood of KT waitlisting.

Methods

Patients who were referred to KT evaluation were recruited into KTFT starting in 2015. Baseline characteristics were collected during a pre-KT evaluation interview. Participants’ medical records were reviewed through 08/2022 for waitlist status. We used Fine-Gray proportional hazards models to examine how sociocultural factors uniquely predicted likelihood of waitlisting, controlling for demographics and clinical factors.

Results

The final sample of KTFT patients included 1107 participants (782 Non-Hispanic White, 243 Non-Hispanic Black, 82 Other). We found that medical mistrust (subdistribution hazard ratio [SHR] = 0.79, 95% CI: 0.70, 0.90) and Black race (SHR = 0.70, 95% CI: 0.55, 0.90) lowered likelihood of waitlisting. After controlling for demographic and clinical factors, the effect of Black race on waitlisting went away, but the influence of medical mistrust on waitlisting was maintained (SHR = 0.86, 95% CI: 0.75, 0.99).

Conclusion

In a cohort of patients who underwent a clinic-level intervention that streamlined the KT evaluation process, we found that medical mistrust, not race, was associated with reduced likelihood of KT waitlisting. These findings suggest that working to reduce KT disparities may involve targeting sociocultural factors that explain race differences, rather than targeting race itself. Such interventions may need to involve targeting multiple levels within the healthcare system (e.g., clinic-level and provider-level intervention) instead of exclusively focusing on a single level.

Funding

• NIDDK Support