Patients with High Priority for Kidney Transplant Who Are Not Given Expedited Placement on the Transplant Waiting List Represent Lost Opportunities

2021 ◽  
pp. ASN.2020081146
Author(s):  
Jesse D. Schold ◽  
Anne M. Huml ◽  
Emilio D. Poggio ◽  
John R. Sedor ◽  
Syed A. Husain ◽  
...  
Keyword(s):  
Deceased Donor ◽  
The United States ◽  
Waiting List ◽  
Survival Models ◽  
Timely Manner ◽  
Black Patients ◽  
Kidney Allocation System ◽  
Living Donor Transplantation ◽  
To Receive ◽  
White Patients

ABSTRACTBackgroundKidney transplantation is associated with the best outcomes for most patients with ESKD. The national Kidney Allocation System prioritizes patients with Estimated Post-Transplant Survival (EPTS) scores in the top 20% for expedited access to optimal deceased donor kidneys.MethodsWe studied adults aged ≥18 years in the United States Renal Data System with top 20% EPTS scores who had been preemptively waitlisted or initiated dialysis in 2015–2017. We evaluated time to waitlist placement, transplantation, and mortality with unadjusted and multivariable survival models.ResultsOf 42,445 patients with top 20% EPTS scores (mean age, 38.0 years; 57% male; 59% White patients, and 31% Black patients), 7922 were preemptively waitlisted. Among 34,523 patients initiating dialysis, the 3-year cumulative waitlist placement incidence was 37%. Numerous factors independently associated with waitlisting included race, income, and having noncommercial insurance. For example, waitlisting was less likely for Black versus White patients, and for patients in the lowest-income neighborhoods versus those in the highest-income neighborhoods. Among patients initiating dialysis, 61% lost their top 20% EPTS status within 30 months versus 18% of patients who were preemptively listed. The 3-year incidence of deceased and living donor transplantation was 5% and 6%, respectively, for patients who initiated dialysis and 26% and 44%, respectively, for patients who were preemptively listed.ConclusionsMany patients with ESKDqualifying with top 20% EPTS status are not placed on the transplant waiting list in a timely manner, with significant variation on the basis of demographic and social factors. Patients who are preemptively listed are more likely to receive benefits of top 20% EPTS status. Efforts to expedite care for qualifying candidates are needed, and automated transplant referral for patients with the best prognoses should be considered.

scholarly journals Utilization of epilepsy surgery in the United States: A study of the National Inpatient Sample investigating the roles of race, socioeconomic status, and insurance

2021 ◽  
Vol 12 ◽  
pp. 546
Author(s):  
Jacob Bernstein ◽  
Samir Kashyap ◽  
Michael W. Kortz ◽  
Bishoy Zakhary ◽  
Ariel Takayanagi ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Epilepsy Surgery ◽  
Surgical Procedure ◽  
Private Insurance ◽  
The United States ◽  
Cross Sectional ◽  
Black Patients ◽  
To Receive ◽  
Income Quartile ◽  
White Patients

Background: Epilepsy is estimated to affect 70 million people worldwide and is medically refractory in 30% of cases. Methods: This is a retrospective cross-sectional study using a US database from 2012 to 2014 to identify patients aged ≥18 years admitted to the hospital with epilepsy as the primary diagnosis. The sampled population was weighted using Healthcare Cost and Utilization Project guidelines. Procedural ICD-9 codes were utilized to stratify the sampled population into two cohorts: resective surgery and implantation or stimulation procedure. Results: Query of the database yielded 152,925 inpatients, of which 8535 patients underwent surgical intervention. The nonprocedural group consisted of 76,000 White patients (52.6%) and 28,390 Black patients (19.7%) while the procedural group comprised 5550 White patients (64%) and 730 Black patients (8.6%) (P < 0.001). Patients with Medicare were half as likely to receive a surgical procedure (14.8% vs. 28.4%) while patients with private insurance were twice as likely to receive a procedure (53.4% vs. 29.3%), both were statistically significant (P < 0.01). Those in the lowest median household income quartile by zip code (<$40,000) were 68% less likely to receive a procedure (21.5% vs. 31.4%) while the highest income quartile was 133% more likely to receive a procedure (26.1% vs. 19.5%). Patients from rural and urban nonteaching hospitals were, by a wide margin, less likely to receive a surgical procedure. Conclusion: We demonstrate an area of need and significant improvement at institutions that have the resources and capability to perform epilepsy surgery. The data show that institutions may not be performing enough epilepsy surgery as a result of racial and socioeconomic bias. Admissions for epilepsy continue to increase without a similar trend for epilepsy surgery despite its documented effectiveness. Race, socioeconomic status, and insurance all represent significant barriers in access to epilepsy surgery. The barriers can be remedied by improving referral patterns and implementing cost-effective measures to improve inpatient epilepsy services in rural and nonteaching hospitals.

scholarly journals Trends in Survival Over the Past Two Decades Among White and Black Patients With Newly Diagnosed Stage IV Breast Cancer

2008 ◽  
Vol 26 (30) ◽  
pp. 4891-4898 ◽  
Author(s):  
Shaheenah Dawood ◽  
Kristine Broglio ◽  
Ana M. Gonzalez-Angulo ◽  
Aman U. Buzdar ◽  
Gabriel N. Hortobagyi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Stage Iv ◽  
The United States ◽  
Breast Cancer Specific Survival ◽  
Newly Diagnosed ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Black Patients ◽  
Stage Iv Breast Cancer ◽  
White Patients

Purpose Overall, breast cancer mortality has been declining in the United States, but survival studies of patients with stage IV disease are limited. The aim of this study was to evaluate trends in and factors affecting survival in a large population-based cohort of patients with newly diagnosed stage IV breast cancer. Patients and Methods We searched the Surveillance, Epidemiology, and End Results registry to identify female patients with stage IV breast cancer diagnosed between 1988 and 2003. Patients were divided into three groups according to year of diagnosis (1988 to 1993, 1994 to 1998, and 1999 to 2003). Survival outcomes were estimated by the Kaplan-Meier method, and Cox models were fit to determine the characteristics independently associated with survival. Results We identified 15,438 patients. Median age was 62 years. Median follow-up was 16 months, 18 months, and 11 months in periods 1988 to 1993, 1994 to 1998, and 1999 to 2003, respectively. Median breast cancer–specific survival was 23 months. In the multivariate model, earlier year of diagnosis, grade 3 disease, increasing age, being unmarried, hormone receptor–negative disease, and no surgery were all independently associated with worse overall and breast cancer–specific survival. With each successive year of diagnosis, black patients had an increasingly greater risk of death compared with white patients (hazard ratio, 1.03; 95% CI, 1.00 to 1.06; P = .031). Conclusion The survival of patients with newly diagnosed stage IV breast cancer has modestly improved over time, but these data suggest that the disparity in survival between black and white patients has increased.

scholarly journals Inequities in Diabetic Ketoacidosis Among Patients With Type 1 Diabetes and COVID-19: Data From 52 US Clinical Centers

2020 ◽  
Author(s):  
Osagie Ebekozien ◽  
Shivani Agarwal ◽  
Nudrat Noor ◽  
Anastasia Albanese-O’Neill ◽  
Jenise C Wong ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
The United States ◽  
Cross Sectional Study ◽  
Multivariable Logistic Regression Analysis ◽  
Cross Sectional ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Abstract Objective We examined whether diabetic ketoacidosis (DKA), a serious complication of type 1 diabetes (T1D) was more prevalent among Non-Hispanic (NH) Black and Hispanic patients with T1D and laboratory-confirmed coronavirus disease 2019 (COVID-19) compared with NH Whites. Method This is a cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 52 clinical sites in the United States, data were collected from April to August 2020. We examined the distribution of patient factors and DKA events across NH White, NH Black, and Hispanic race/ethnicity groups. Multivariable logistic regression analysis was performed to examine the odds of DKA among NH Black and Hispanic patients with T1D as compared with NH White patients, adjusting for potential confounders, such as age, sex, insurance, and last glycated hemoglobin A1c (HbA1c) level. Results We included 180 patients with T1D and laboratory-confirmed COVID-19 in the analysis. Forty-four percent (n = 79) were NH White, 31% (n = 55) NH Black, 26% (n = 46) Hispanic. NH Blacks and Hispanics had higher median HbA1c than Whites (%-points [IQR]: 11.7 [4.7], P &lt; 0.001, and 9.7 [3.1] vs 8.3 [2.4], P = 0.01, respectively). We found that more NH Black and Hispanic presented with DKA compared to Whites (55% and 33% vs 13%, P &lt; 0.001 and P = 0.008, respectively). After adjusting for potential confounders, NH Black patients continued to have greater odds of presenting with DKA compared with NH Whites (OR [95% CI]: 3.7 [1.4, 10.6]). Conclusion We found that among T1D patients with COVID-19 infection, NH Black patients were more likely to present in DKA compared with NH White patients. Our findings demonstrate additional risk among NH Black patients with T1D and COVID-19.

scholarly journals Race and Insurance Differences in the Receipt of Adjuvant Chemotherapy Among Patients With Stage III Colon Cancer

2015 ◽  
Vol 33 (23) ◽  
pp. 2530-2536 ◽  
Author(s):  
Caitlin C. Murphy ◽  
Linda C. Harlan ◽  
Joan L. Warren ◽  
Ann M. Geiger
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Private Insurance ◽  
The United States ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Time Period ◽  
Black Patients ◽  
Incidence And Mortality ◽  
White Patients

Purpose Although the incidence and mortality of colon cancer in the United States has declined over the past two decades, blacks have worse outcomes than whites. Variations in treatment may contribute to mortality differentials. Methods Patients diagnosed with stage III colon cancer were randomly sampled from the SEER program from the years 1990, 1991, 1995, 2000, 2005, and 2010. Patients were categorized as non-Hispanic white (n = 835) or black (n = 384). Treatment data were obtained from a review of the medical records, and these data were verified through contact with the original treating physicians. Log-binomial regression models were used to estimate the association between race and receipt of adjuvant chemotherapy. Effect modification by insurance was assessed with use of single referent models. Results Receipt of adjuvant chemotherapy among both white and black patients increased from the period encompassing the years 1990 and 1991 (white, 58%; black, 45%) to the year 2005 (white, 72%; black, 71%) and then decreased in the year 2010 (white, 66%; black, 57%). There were marked racial disparities in the time period of 1990 to 1991 and again in 2010, with black patients less likely to receive adjuvant chemotherapy as compared with white patients (risk ratio [RR], .82; 95% CI, .72 to .93). For black patients, receipt of adjuvant chemotherapy did not differ across insurance categories (RR for private insurance, .80; 95% CI, .69 to .93; RR for Medicare, .84; 95% CI, .69 to 1.02; and RR for Medicaid, .84; 95% CI, .69 to 1.02), although a larger proportion had Medicaid in all years of the study as compared with white patients. Conclusion The chemotherapy differential narrowed after the time period of 1990 to 1991, but our findings suggest that the disparity reemerged in 2010. Recent decreases in chemotherapy use may be due, in part, to the economic downturn and an increase in Medicaid coverage.

scholarly journals GSTP1 positive prostatic adenocarcinomas are more common in Black than White men in the United States

2020 ◽  
Author(s):  
Igor Vidal ◽  
Qizhi Zheng ◽  
Jessica L. Hicks ◽  
Jiayu Chen ◽  
Elizabeth A. Platz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Black Men ◽  
Cpg Island ◽  
Molecular Subtype ◽  
White Men ◽  
The United States ◽  
Dna Hypermethylation ◽  
Black Patients ◽  
Prostate Cancers ◽  
White Patients

GSTP1 is a member of the Glutathione-S-transferase (GSTS) family silenced by CpG island DNA hypermethylation in 90-95% of prostate cancers. However, prostate cancers expressing GSTP1 have not been well characterized. We used immunohistochemistry against GSTP1 to examine 1673 primary prostatic adenocarcinomas on TMAs with redundant sampling from the index tumor from prostatectomies. GSTP1 protein was positive in at least one TMA core in 7.7% of cases and in all TMA cores in 4.4% of cases. The percentage of adenocarcinomas from Black patients who had any GSTP1 positive TMA cores was 14.9%, which was 2.5 times higher than the percentage from White patients (5.9%; P < 0.001). Further, the percentages of tumors from Black patients who had all TMA spots positive for GSTP1 (9.5%) was 3-fold higher than the percentage from White patients (3.2%; P<0.001). The increased percentage of GSTP1 positive cases in Black men was present only in ERG positive cases. By in situ hybridization, GSTP1 mRNA expression was concordant with protein staining, supporting the lack of silencing of at least some GSTP1 alleles in GSTP1-positive tumor cells. This is the first report revealing that the GSTP1-positive prostate cancer subset is substantially over-represented among prostate cancers from Black compared to White men. This observation should prompt additional studies to determine whether GSTP1 positive cases represent a distinct molecular subtype of prostate cancer and whether GSTP1 expression could provide a biological underpinning for the observed disparate outcomes for Black men.

Association between Longer Travel Distance for Transplant Care and Access to Kidney Transplantation and Graft Survival in the United States

2021 ◽  
pp. ASN.2020081242
Author(s):  
Adrian M. Whelan ◽  
Kirsten L. Johansen ◽  
Sandeep Brar ◽  
Charles E. McCulloch ◽  
Deborah B. Adey ◽  
...  
Keyword(s):  
United States ◽  
Kidney Transplantation ◽  
Graft Failure ◽  
Living Donor ◽  
Deceased Donor ◽  
The United States ◽  
Travel Distance ◽  
Transplant Center ◽  
Living Donor Transplantation ◽  
Transplant Candidates

BackgroundTransplant candidates may gain an advantage by traveling to receive care at a transplant center that may have more favorable characteristics than their local center. Factors associated with longer travel distance for transplant care and whether the excess travel distance (ETD) is associated with access to transplantation or with graft failure are unknown.MethodsThis study of adults in the United States wait-listed for kidney transplantation in 1995–2015 used ETD, defined as distance a patient traveled beyond the nearest transplant center for initial waiting list registration. We used linear regression to examine patient and center characteristics associated with ETD and Fine–Gray models to examine the association between ETD (modeled as a spline) and time to deceased or living donor transplantation or graft failure.ResultsOf 373,365 patients, 11% had an ETD≥50 miles. Traveling excess distance was more likely among patients who were of non-Black race or those whose nearest transplant center had lower annual living donor transplant volume. At an ETD of 50 miles, we observed a lower likelihood of deceased donor transplantation (subhazard ratio [SHR], 0.85; 95% confidence interval [95% CI], 0.84 to 0.87) but higher likelihood of living donor transplantation (SHR, 1.14; 95% CI, 1.12 to 1.16) compared with those who received care at their nearest center. ETD was weakly associated with higher risk of graft failure.ConclusionsPatients who travel excess distances for transplant care have better access to living donor but not deceased donor transplantation and slightly higher risk of graft failure. Traveling excess distances is not clearly associated with better outcomes, especially if living donors are unavailable.

Racial disparities in emergency care for seizures in the United States

2021 ◽  
Vol 13 (9) ◽  
pp. 373-377
Author(s):  
Sriman Gaddam
Keyword(s):  
Relative Risk ◽  
Racial Disparities ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Life Support ◽  
The United States ◽  
Chi Square ◽  
Time Critical ◽  
To Receive ◽  
White Patients

Background: Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure. Aims: This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure. Methods: This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk. Findings: On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients. Conclusions: Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

Cancer- Associated Venous Thromboembolism (VTE) Characteristics in Blacks Compared to Whites in Durham County, North Carolina

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3652-3652
Author(s):  
Ibrahim Saber ◽  
Maragatha Kuchibhatla ◽  
Alys Adamski ◽  
Lisa C. Richardson ◽  
Nimia Reyes ◽  
...  
Keyword(s):  
North Carolina ◽  
Venous Thromboembolism ◽  
Hematologic Malignancies ◽  
The United States ◽  
University Hospital ◽  
Black And White ◽  
Patients With Cancer ◽  
Black Patients ◽  
Active Cancer ◽  
White Patients

Introduction: Venous thromboembolism (VTE), defined as deep vein thrombosis (DVT), pulmonary embolism (PE), or both, represents a major cause of morbidity and mortality in patients with cancer. VTE is the second leading cause of death in patients with cancer, after cancer itself, in the United States. Previous studies have suggested differences by race in the occurrence of VTE among cancer patients. The purpose of this study was to investigate clinical differences in black and white patients with VTE and cancer. Methods: We conducted an analysis of a CDC/Duke VTE surveillance project at the three hospitals in Durham County, North Carolina (Duke University Hospital, Duke Regional Hospital and the Durham VA Medical Center) from April 2012 through March 2014. A combination of electronic and manual review methods were used to identify unique Durham County residents with new diagnoses of objectively confirmed VTE. Data abstracted included demographics, risk factors including cancer, clinical data, treatment, and outcomes. Results: A total of 1028 patients with a new VTE were identified during the surveillance period. Twenty-seven patients who were not black or white (e.g., race not listed; Asian; etc), and 41 with VTE affecting areas other than PE or limb DVT (e.g., cerebral sinus venous thrombosis) were excluded from this analysis. Of the remaining 960 patients, slightly more than half were female (497/960=51.8%), more than half were black (508/960=52.9%), almost a third were obese (337/960 = 35.1%), and median age was 59 years old. At the time of their VTE diagnosis, 184 patients with VTE (19.2%) had active cancer, defined as metastatic or diagnosed within the previous 6 months. The proportion of VTE associated with cancer varied by race. Among the 508 black patients with VTE, 111 (21.9%) had active cancer; in comparison, among the 452 white patients with VTE, 73 (16.1%) had active cancer (p-value=0.025). Black patients with VTE and cancer were older, had a lower body mass index (BMI), and were less likely to have sustained a prior VTE compared to black patients with VTE who did not have cancer (Table 1). Similarly, white patients with VTE and cancer had a lower BMI than white patients without cancer (Table 1). However, in contrast to the findings for black patients, white patients with VTE and cancer were not significantly older and did not show differences in having a prior VTE than white patients with VTE who did not have cancer. Additionally, white patients with VTE and cancer were much more likely to have sustained a PE, with or without DVT, and less likely to have sustained a DVT alone, than white patients with VTE who did not have cancer (Table 1). Black and white patients with both VTE and cancer, were similar in several aspects; however, white patients were less likely to have sustained a DVT alone and more likely to have sustained a PE, with or without DVT, compared to black patients. The types of cancer most frequently encountered in black patients with VTE were gastrointestinal (24.3%), genitourinary (23.4%), and lung (18.9%), followed by breast (8.1%), gynecologic (9.0%) and hematologic malignancies (9.9%). The types of cancer most frequently encountered in white patients with VTE were lung (27.4%), breast (16.4%), and gastrointestinal (13.7%), followed by genitourinary (9.6%), gynecologic (8.2%) and hematologic malignancies (6.8%). Black and white patients with VTE and cancer were treated similarly to black and white patients with VTE who did not have cancer, with most receiving anticoagulant therapy and fewer than 10% receiving an IVC filter (Table 1). Enoxaparin was used most frequently, followed by warfarin. Conclusions: There are several notable demographic and clinical differences between patients with VTE with and without cancer. While differences were observed for both black and white patients, several factors that were variable according to cancer status were unique to either black patients or white patients. One notable difference between black and white patients with both VTE and cancer was a lower proportion of DVT only and a higher proportion of PE, with or without DVT, in white patients. Disclosures Ortel: Instrumentation Laboratories: Consultancy.

Sign in / Sign up

Export Citation Format

Share Document