Reducing racial disparities in transplant activation: Whom should we target?

Several studies have documented that blacks with end-stage renal disease (E SRD) are less likely than whites to be placed on the waiting list for a ren al transplant. We examined trends in access over time to determine whether publication of these reports resulted in a reduction in disparity and ident ified those blacks who were most affected to focus future interventions. Th ree nationally representative groups of adult patients with ESRD (first dia lysis in 1986 to 1987, 1990, or 1993) were followed up longitudinally to as certain the date of first placement on the renal transplant waiting list. C ox proportional hazards models were used to characterize the magnitude of r acial disparities in access to the waiting list with adjustment for clinica l and sociodemographic factors. Lower rates of placement on the waiting lis t for blacks than whites persisted after adjustment for differences in both sociodemographic characteristics and health status (relative hazard [RH], 0.68; 95% confidence interval [CI], 0.59 to 0.79). The gap between blacks a nd whites did not narrow over time (blacks versus whites: 1986 to 1987 grou p, RH, 0.71; 95% CI, 0.59 to 0.86; 1990 group, RH, 0.69; 95% CI, 0.54 to 0. 91; 1993 group, RH, 0.57; 0.43 to 0.77) and was greatest for the youngest a nd healthiest black patients, who were 50% and 40% less likely to be listed than corresponding whites, respectively. Interventions targeted toward you ng and healthy blacks, who are most likely to benefit from transplantation, are urgently needed to narrow black-white differences in transplant activa tion. (C) 2001 by the National Kidney Foundation, Inc.