Myaskovsky L (VAPHS and University of Pittsburgh, School of Medicine), Dew MA
(University of Pittsburgh, School of Medicine), Switzer GE
(VAPHS and University of Pittsburgh, School of Medicine), Hritz V
(VAPHS ), Ramkumar M
(VAPHS ), Shapiro R
(University of Pittsburgh, School of Medicine)
African Americans (AAs) are four times as likely as European Americans (EAs) to have end stage renal disease (ESRD), but only half as likely to receive living donor kidney transplants (LDKT), the optimal treatment for ESRD. Reasons for race disparities in LDKT are poorly understood. This study was designed to examine how cultural factors (e.g., perceived discrimination, medical mistrust, religious objection to transplant), transplant knowledge, and psychosocial characteristics (e.g., coping, social support, anxiety) contribute to race disparities in LDKT.
ESRD patients being evaluated for kidney transplant either at the VA Pittsburgh Healthcare System (VAPHS) or at the University of Pittsburgh Medical Center (UPMC) completed telephone interviews shortly after their first transplant clinic appointment (n=131).
Demographic comparisons using chi-square analyses indicated that AA (n=34) and EA (n=97) patients did not differ on most demographic characteristics, although AA candidates tended to have lower status occupations and lower incomes than did EA candidates. Group comparison analyses using t-tests showed that AAs reported experiencing significantly more discrimination in healthcare, perceived more overall racism, had higher levels of medical mistrust, felt more family loyalty, and indicated more religious objections to LDKT than did EAs (all ps < .01). However, AA candidates had significantly less transplant-related knowledge than did EAs (p < .01). Among psychosocial characteristics, AA transplant candidates engaged in higher levels of avoidant coping than EA candidates (p < .05). Patients who had more transplant knowledge had a greater likelihood of having a potential living donor (r =.29, p < .001), were more likely to be having a potential donor being evaluated (r =.32, p < .05), and were more likely to have already found that a potential donor was not a good match for them (r =.31, p < .05).
Thus, while AA and EA transplant candidates differed in levels of cultural factors, transplant knowledge, and psychosocial characteristics, only transplant knowledge was related to transplant preference.
These findings suggest that while patients’ cultural concerns are important to consider when designing educational material about transplantation, providing patients with more information about LDKT is an essential component to help increase the rate of LDKT among AA ESRD patients.