Valerie L. Thompson, Yiting Li, Yi Liu, Jingyao Hong, Swati Sharma, Garyn Metoyer, Maya N. Clark-Cutaia, Tanjala S. Purnell, Deidra C. Crews, Dorry L. Segev, Mara McAdams-DeMarco
{"title":"肾移植候选者对医疗的不信任。","authors":"Valerie L. Thompson, Yiting Li, Yi Liu, Jingyao Hong, Swati Sharma, Garyn Metoyer, Maya N. Clark-Cutaia, Tanjala S. Purnell, Deidra C. Crews, Dorry L. Segev, Mara McAdams-DeMarco","doi":"10.1111/ctr.15395","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Medical distrust may hinder kidney transplantation (KT) access. Among KT candidates evaluated for waitlisting, we identified factors associated with high distrust levels and quantified their association with waitlisting.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Among 812 candidates (2018–2023), we assessed distrust using the Revised Health Care System Distrust Scale across composite, competence, and values subscales. We used linear regression to quantify the associations between candidate and neighborhood-level factors and distrust scores. We used Cox models to quantify the associations between distrust scores and waitlisting.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>At KT evaluation, candidates who were aged 35–49 years (difference = 1.97, 95% CI: 0.78–3.16), female (difference = 1.10, 95% CI: 0.23–1.97), and Black (difference = 1.47, 95% CI: 0.47–2.47) were more likely to report higher composite distrust score. For subscales, candidates aged 35–49 were more likely to have higher competence distrust score (difference = 1.14, 95% CI: 0.59–1.68) and values distrust score (difference = 0.83, 95% CI: 0.05–1.61). Race/ethnicity (Black, difference = 1.42, 95% CI: 0.76–2.07; Hispanic, difference = 1.52, 95% CI: 0.35–2.69) was only associated with higher values distrust scores. Female candidates reporting higher rescaled values distrust scores (each one point) had a lower chance of waitlisting (aHR = 0.78, 95% CI: 0.63–0.98), whereas this association was not observed among males. Similarly, among non-White candidates, each 1-point increase in both rescaled composite (aHR = 0.87, 95% CI: 0.77–0.99) and values (aHR = 0.82, 95% CI: 0.68–0.99) distrust scores was associated with a lower chance of waitlisting, while there was no association among White candidates.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Female, younger, and non-White candidates reported higher distrust scores. Values distrust may contribute to the long-standing racial/ethnic and gender disparities in access to KT. Implementing tailored strategies to reduce distrust in transplant care may improve KT access for groups that experience persistent disparities.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Medical Distrust Among Kidney Transplant Candidates\",\"authors\":\"Valerie L. Thompson, Yiting Li, Yi Liu, Jingyao Hong, Swati Sharma, Garyn Metoyer, Maya N. Clark-Cutaia, Tanjala S. Purnell, Deidra C. Crews, Dorry L. Segev, Mara McAdams-DeMarco\",\"doi\":\"10.1111/ctr.15395\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Medical distrust may hinder kidney transplantation (KT) access. Among KT candidates evaluated for waitlisting, we identified factors associated with high distrust levels and quantified their association with waitlisting.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Among 812 candidates (2018–2023), we assessed distrust using the Revised Health Care System Distrust Scale across composite, competence, and values subscales. We used linear regression to quantify the associations between candidate and neighborhood-level factors and distrust scores. We used Cox models to quantify the associations between distrust scores and waitlisting.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>At KT evaluation, candidates who were aged 35–49 years (difference = 1.97, 95% CI: 0.78–3.16), female (difference = 1.10, 95% CI: 0.23–1.97), and Black (difference = 1.47, 95% CI: 0.47–2.47) were more likely to report higher composite distrust score. For subscales, candidates aged 35–49 were more likely to have higher competence distrust score (difference = 1.14, 95% CI: 0.59–1.68) and values distrust score (difference = 0.83, 95% CI: 0.05–1.61). Race/ethnicity (Black, difference = 1.42, 95% CI: 0.76–2.07; Hispanic, difference = 1.52, 95% CI: 0.35–2.69) was only associated with higher values distrust scores. Female candidates reporting higher rescaled values distrust scores (each one point) had a lower chance of waitlisting (aHR = 0.78, 95% CI: 0.63–0.98), whereas this association was not observed among males. Similarly, among non-White candidates, each 1-point increase in both rescaled composite (aHR = 0.87, 95% CI: 0.77–0.99) and values (aHR = 0.82, 95% CI: 0.68–0.99) distrust scores was associated with a lower chance of waitlisting, while there was no association among White candidates.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Female, younger, and non-White candidates reported higher distrust scores. Values distrust may contribute to the long-standing racial/ethnic and gender disparities in access to KT. Implementing tailored strategies to reduce distrust in transplant care may improve KT access for groups that experience persistent disparities.</p>\\n </section>\\n </div>\",\"PeriodicalId\":10467,\"journal\":{\"name\":\"Clinical Transplantation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Transplantation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/ctr.15395\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.15395","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Medical Distrust Among Kidney Transplant Candidates
Background
Medical distrust may hinder kidney transplantation (KT) access. Among KT candidates evaluated for waitlisting, we identified factors associated with high distrust levels and quantified their association with waitlisting.
Methods
Among 812 candidates (2018–2023), we assessed distrust using the Revised Health Care System Distrust Scale across composite, competence, and values subscales. We used linear regression to quantify the associations between candidate and neighborhood-level factors and distrust scores. We used Cox models to quantify the associations between distrust scores and waitlisting.
Results
At KT evaluation, candidates who were aged 35–49 years (difference = 1.97, 95% CI: 0.78–3.16), female (difference = 1.10, 95% CI: 0.23–1.97), and Black (difference = 1.47, 95% CI: 0.47–2.47) were more likely to report higher composite distrust score. For subscales, candidates aged 35–49 were more likely to have higher competence distrust score (difference = 1.14, 95% CI: 0.59–1.68) and values distrust score (difference = 0.83, 95% CI: 0.05–1.61). Race/ethnicity (Black, difference = 1.42, 95% CI: 0.76–2.07; Hispanic, difference = 1.52, 95% CI: 0.35–2.69) was only associated with higher values distrust scores. Female candidates reporting higher rescaled values distrust scores (each one point) had a lower chance of waitlisting (aHR = 0.78, 95% CI: 0.63–0.98), whereas this association was not observed among males. Similarly, among non-White candidates, each 1-point increase in both rescaled composite (aHR = 0.87, 95% CI: 0.77–0.99) and values (aHR = 0.82, 95% CI: 0.68–0.99) distrust scores was associated with a lower chance of waitlisting, while there was no association among White candidates.
Conclusion
Female, younger, and non-White candidates reported higher distrust scores. Values distrust may contribute to the long-standing racial/ethnic and gender disparities in access to KT. Implementing tailored strategies to reduce distrust in transplant care may improve KT access for groups that experience persistent disparities.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
