确定移植护理过程中何时出现种族和民族差异：一项全国登记研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2024-10-01 DOI:10.1016/j.lana.2024.100895

Maya N. Clark-Cutaia , Gayathri Menon , Yiting Li , Garyn T. Metoyer , Mary Grace Bowring , Byoungjun Kim , Babak J. Orandi , Stephen P. Wall , Melissa D. Hladek , Tanjala S. Purnell , Dorry L. Segev , Mara A. McAdams-DeMarco

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引用次数: 0

摘要

背景少数群体终末期肾病（ESKD）患者接受肾移植（KT）的人数较少；迄今为止，为缩小差距所做的努力均以失败告终。要实现公平，关键在于准确定位移植护理连续体（获知肾移植选择、加入候选名单到接受肾移植）中各少数群体出现差异的具体阶段。因此，我们对整个 KT 治疗过程中的种族和民族差异进行了量化。方法我们进行了一项回顾性队列研究（2015-2020 年），随访至 2021 年 10 月 12 日。通过美国国家登记数据确定了发生透析的患者。种族和民族（亚裔、黑人、西班牙裔和白人）是暴露的因素。我们使用调整后的修正泊松回归来量化获知 KT 的调整患病率比 (aPR)，并使用特定病因危险模型来计算列名和列名后移植的调整危险比 (aHR)。研究结果在 637,951 名开始透析的成人中，平均年龄（SD）为 63.8 (14.6)，女性占 41.8%，亚裔占 5.4%，黑人占 26.3%，西班牙裔占 16.6%，白人占 51.7%（中位随访年数 [IQR]：1.92 [0.97-3.39]）。相对于白人患者，黑人和西班牙裔患者被告知 KT 的可能性略高（黑人：aPR = 1.02，95% 置信区间 [CI]：1.01-1.02；西班牙裔：aPR = 1.03，95% 置信区间 [CI]：1.02-1.03）。亚裔患者更有可能被列名（aHR = 1.18，95% CI：1.15-1.21），但接受 KT 的可能性较低（aHR = 0.56，95% CI：0.54-0.58）。黑人和西班牙裔患者被列入名单（黑人：aHR = 0.87，95% CI：0.85-0.88；西班牙裔：aHR = 0.85，95% CI：0.85-0.88）和接受 KT 的可能性都较低（黑人：aHR = 0.61，95% CI：0.60-0.63；西班牙裔：aHR = 0.64，95% CI：0.63-0.66）。解释需要进一步确定每个种族和族裔群体在接受 KT 方面所面临的障碍，以及在整个 KT 治疗过程中应对这些不同挑战的干预措施；我们的研究结果确定了最需要缓解的特定阶段。

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Identifying when racial and ethnic disparities arise along the continuum of transplant care: a national registry study

Background

Fewer minoritized patients with end-stage kidney disease (ESKD) receive kidney transplantation (KT); efforts to mitigate disparities have thus far failed. Pinpointing the specific stage(s) within the transplant care continuum (being informed of KT options, joining the waiting list, to receiving KT) where disparities emerge among each minoritized population is pivotal for achieving equity. We therefore quantified racial and ethnic disparities across the KT care continuum.

Methods

We conducted a retrospective cohort study (2015–2020), with follow-up through 12/10/2021. Patients with incident dialysis were identified using the US national registry data. The exposure was race and ethnicity (Asian, Black, Hispanic, and White). We used adjusted modified Poisson regression to quantify the adjusted prevalence ratio (aPR) of being informed of KT, and cause-specific hazards models to calculate adjusted hazard ratios (aHR) of listing, and transplantation after listing.

Findings

Among 637,951 adults initiating dialysis, the mean age (SD) was 63.8 (14.6), 41.8% were female, 5.4% were Asian, 26.3% were Black, 16.6% were Hispanic, and 51.7% were White (median follow-up in years [IQR]:1.92 [0.97–3.39]). Black and Hispanic patients were modestly more likely to be informed of KT (Black: aPR = 1.02, 95% confidence interval [CI]:1.01–1.02; Hispanic: aPR = 1.03, 95% CI: 1.02–1.03) relative to White patients. Asian patients were more likely to be listed (aHR = 1.18, 95% CI: 1.15–1.21) but less likely to receive KT (aHR = 0.56, 95% CI: 0.54–0.58). Both Black and Hispanic patients were less likely to be listed (Black: aHR = 0.87, 95% CI: 0.85–0.88; Hispanic: aHR = 0.85, 95% CI: 0.85–0.88) and receive KT (Black: aHR = 0.61, 95% CI: 0.60–0.63; Hispanic: aHR = 0.64, 95% CI: 0.63–0.66).

Interpretation

Improved characterization of the barriers in KT access specific to each racial and ethnic group, and the interventions to address these distinct challenges throughout the KT care continuum are needed; our findings identify specific stages most in need of mitigation.

Funding

National Institutes of Health.

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.