Kidney Week

Abstract: FR-PO1041

Socioeconomic Factors Affect Access to Kidney Transplant in the Ohio River Valley

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

• Kelty, Catherine E., Indiana University School of Medicine, Indianapolis, Indiana, United States

Catherine E. Kelty, PhD

• Wilk, Adam S., Indiana University School of Medicine, Indianapolis, Indiana, United States

Adam S. Wilk, PhD

• Adebiyi, Oluwafisayo O., Indiana University School of Medicine, Indianapolis, Indiana, United States

Oluwafisayo O. Adebiyi, MD, FASN

• Sharfuddin, Asif A., Indiana University School of Medicine, Indianapolis, Indiana, United States

Asif A. Sharfuddin, MD, FASN

• Fridell, Jonathan Aaron, Indiana University School of Medicine, Indianapolis, Indiana, United States

Jonathan Aaron Fridell, MD

• Sher, Syed Jawad, Indiana University School of Medicine, Indianapolis, Indiana, United States

Syed Jawad Sher, MD, FASN

• Huml, Anne M., Cleveland Clinic, Cleveland, Ohio, United States

Anne M. Huml, MD, MS

• Pastan, Stephen O., Emory University, Atlanta, Georgia, United States

Stephen O. Pastan, MD

• Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States

Sharon M. Moe, MD, FASN

• Patzer, Rachel E., Regenstrief Institute Inc, Indianapolis, Indiana, United States

Rachel E. Patzer, PhD, MPH

Background

Kidney transplant (KTx) improves patient survival and quality of life compared to dialysis, though many inequities exist due to social factors critical for fostering KTx access. To improve equity in KTx in the Ohio River Valley (IN, KY, OH), we must first understand the social drivers of health affecting access in our region.

Methods

Adult patients with incident end stage kidney disease residing in IN, KY, or OH at dialysis start among n=680 dialysis facilities from January 2016-June 2020 (followed through June 2021) were assessed. U.S. Renal Data System data were linked to referral and evaluation data from n=4 KTx centers contributing to the Early Steps to Transplant Access Registry and ZIP code-level characteristics from the 2021 American Community Survey. Associations were assessed between social and clinical variables and key outcomes: 1) evaluation start within 6 months of referral among referred patients, 2) waitlisting within 6 months of evaluation start among all evaluated, and 3) days between these events. Associations were examined—overall and in patient samples stratified by ZIP code-level median household income tertiles—by multivariable logistic regression and log rank test.

Results

Of n=8824 referred patients, 3265 (37%) started evaluation within 6 months and 981 (11%) were waitlisted within 6 months. More patients starting evaluation within 6 months were from high-income areas (39%) vs. middle (29%) and low (32%) (p<0.001). Overall, access to KTx was poorer for low-income (vs. high-income), as well as for Medicaid-insured (vs. commercial), Black (vs. non-Hispanic White), and female (vs. male) patients. Inequities were broadly consistent across income groups. For example, Medicaid-insured patients had a longer median time from evaluation start to waitlisting (197 days) vs. commercial insurance (121 days) in low-income areas (p=0.004); this disparity was 189 vs. 115 days for high-income (p=0.047).

Conclusion

Patients with Medicaid or living in low-income ZIP codes in the Ohio River Valley had reduced access to prewaitlisting KTx services relative to patients with commercial insurance or in high-income areas. This suggests that interventions to improve equity in KTx access should target patients in low-income areas and those without private insurance.

Funding

• Other NIH Support