Population Health, Ethnicity and Rate of Living Donor Kidney Transplantation

Background Living donor kidney transplantation has declined in the United States since 2004, but the relationship between population characteristics and rate of living donation is unknown. The goal of our study was to use data on general population health and socioeconomic status to investigate the association with living donation. Methods This cross-sectional, ecological study used population health and socioeconomic status data from the CDC Behavioral Risk Factor Surveillance System (BRFSS) to investigate the association with living donation. Transplant centers performing ≥ 10 kidney transplants reported to the Scientific Registry of Transplant Recipients in 2015 were included. Center rate of living donation was defined as the proportion of all kidney transplants performed at a center that were from living donors. Results In a linear mixed effects model, a composite index of health and socioeconomic status factors was negatively associated with living donation, with a rate of living donation that was on average 7.3 percentage points lower among centers in areas with more comorbid disease and poorer socioeconomic status (95% CI: -12.2 to -2.3, p=0.004). Transplant centers in areas with higher prevalence of minorities had a rate of living donation that was 7.1 percentage points lower than centers with fewer minorities (95% CI: -11.8 to -2.3, p=0.004). Conclusions Center level variation in living donation was associated with population characteristics and minority prevalence. Further examination of these factors in the context of patient and center-level barriers to living donation is warranted. Corresponding Author: Jayme E. Locke MD MPH (author from whom reprints will be available), University of Alabama at Birmingham, 701 19th Street South, LHRB 748, Birmingham, AL 35294. (205) 934-2131. Email: jlocke@uabmc.edu AUTHOR CONTRIBUTIONS Research idea and study design: RDR, DS, BAS, PAM, JEL; data acquisition: RDR; data analysis/interpretation: RDR, DS, BAS, PAM, CEL, JEL; statistical analysis: RDR, DL; supervision or mentorship: DS, PAM, MH, VK, DL, RG, MK, BJ, CEL, JEL. Each author contributed important intellectual content during manuscript drafting and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated or resolved. DISCLOSURES None FUNDING This research was supported in part by the National Institutes of Health grant numbers K23-DK103918 (PI: Locke) and R01-DK113980 (PI: Locke). The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or US Government. These data were presented in preliminary form at the 2017 American Transplant Congress in Chicago, IL. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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