PT - JOURNAL ARTICLE AU - Wesselman, Hannah AU - Ford, Christopher Graham AU - Leyva, Yuridia AU - Li, Xingyuan AU - Chang, Chung-Chou H. AU - Dew, Mary Amanda AU - Kendall, Kellee AU - Croswell, Emilee AU - Pleis, John R. AU - Ng, Yue Harn AU - Unruh, Mark L. AU - Shapiro, Ron AU - Myaskovsky, Larissa TI - Social Determinants of Health and Race Disparities in Kidney Transplant AID - 10.2215/CJN.04860420 DP - 2021 Feb 08 TA - Clinical Journal of the American Society of Nephrology PG - 262--274 VI - 16 IP - 2 4099 - http://cjasn.asnjournals.org/content/16/2/262.short 4100 - http://cjasn.asnjournals.org/content/16/2/262.full SO - CLIN J AM SOC NEPHROL2021 Feb 08; 16 AB - Background and objectives Black patients have a higher incidence of kidney failure but lower rate of deceased- and living-donor kidney transplantation compared with White patients, even after taking differences in comorbidities into account. We assessed whether social determinants of health (e.g., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living-donor kidney transplantation.Design, setting, participants, & measurements Via medical record review, we prospectively followed 1056 patients referred for kidney transplant (2010–2012), who completed an interview soon after kidney transplant evaluation, until their kidney transplant. We used multivariable competing risk models to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome.Results Even after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, less transplant knowledge, and fewer learning activities were each associated with a lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, and fewer learning activities were each associated with a lower probability of deceased-donor transplant. Black race, older age, lower income, public insurance, higher body mass index, dialysis before kidney transplant, not presenting with a potential living donor, religious objection to living-donor transplant, and less transplant knowledge were each associated with a lower probability of living-donor transplant.Conclusions Race and social determinants of health are associated with the likelihood of undergoing kidney transplant.