Racial disparities in access to simultaneous pancreas-kidney transplantation in the United States

The purpose of our study is to assess the extent of racial differences in t he access to simultaneous pancreas-kidney (SPK) transplantation and evaluat e the potential influence of socioeconomic factors on access to transplanta tion. We performed a retrospective analysis of the US Renal Data System and United Network for Organ Sharing data on all patients with end-stage renal disease (ESRD) due to diabetes mellitus from 1988 to 1996 (0 = 562,814), i ncluding all dialysis, wait list, and transplant patients, Racial differenc es in incidence, prevalence, insurance coverage, employment status, and tra nsplantation rates were calculated. Caucasians had the highest prevalence o f ESRD caused by type 1 diabetes (73%), followed by blacks (22%), Hispanics (3%), Native Americans (2%), and others (<1%), Both blacks and Native Amer icans increased their annual incidence of ESRD caused by insulin-dependent diabetes mellitus by 10% compared with only a 3.5% increase in Caucasians, whereas incidence rates increased annually by almost 8% for both blacks and Native Americans compared with a 3% Increase for Caucasians, However, Cauc asians received 92% of all SPK transplants, whereas all other racial groups combined received a disproportionate minority of the remaining transplants . Lack of private insurance and unemployment status were associated with an nual changes in both incidence of ESRD caused by type 1 diabetes and SPK tr ansplant rates, In conclusion, we observed striking racial disparities for access to SPK transplantation in the United States today, which may be rela ted to employment status, access to private insurance, and subsequent healt h care. Our preliminary data support current efforts to encourage Medicare and Medicaid coverage for all patients requiring SPK transplantation regard less of racial or financial status. (C) 2000 by the National Kidney Foundat ion, Inc.