The Final Rule aimed to reduce geographic disparities in access to transplantation by prioritizing need for transplant over donor proximity. However, disparities in waiting times persist for deceased donor kidney transplantation. The Kidney Allocation System implemented in 2014 does not account for potential local supply based on population health characteristics within a Donation Service Area (DSA). We hypothesized that regions with traditionally high rates of comorbid disease, such as the states located along the Gulf of Mexico (Gulf States), may be disadvantaged by limited local supply secondary to poor population health.
Using data from the Robert Wood Johnson Foundation County Health Rankings, the United States Renal Data System, and the Scientific Registry of Transplant Recipients, we compared population-level characteristics and expected kidney donation rates by Gulf States location.
Prevalence of African American ethnicity, ESRD, diabetes, fair/poor self-rated health, physical inactivity, food insecurity, and uninsurance were higher among Gulf State DSAs. On unadjusted analyses, Gulf State DSAs were associated with 3.52 fewer expected kidney donors per 100 eligible deaths than non-Gulf States. After adjustment, there was no longer a statistically significant difference in expected kidney donation rate.
While Gulf State DSAs have lower expected donation rates, these differences appear to be driven by the prevalence of health factors negatively associated with donation rate. These data suggest the need to discuss population health characteristics when examining kidney allocation policy, to account for potential lower supply of donors and to further address geographic disparities in access to kidney transplantation.
1 Department of Surgery, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL
2 Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Author Contributions: JEL and RDR had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analyses. RDR conceived and designed the study, with oversight from JEL and PAM. BAS, MNM, and DS participated in interpretation of the data and revision of the article, and all authors gave final approval of the manuscript. RDR drafted the article and was responsible for the statistical analyses.
Disclosure: The authors declare no conflicts of interest.
Funding: This work was supported in part by the Gulf States Health Policy Center grant # 5 U54 MD008602-05 (PI: RD Reed).
ACKNOWLEDGEMENTS: This work was supported by the Gulf States Health Policy Center # 5 U54 MD008602-05. These data were presented in preliminary form at the 2018 Minority Health Disparities Research Symposium at the University of Alabama at Birmingham in Birmingham, AL and at the American Heart Association 2018 Epi Lifestyle and Scientific Sessions in New Orleans, LA.
The data reported here have been supplied by the United States Renal Data System (USRDS) and the Minneapolis Medical Research Foundation as the contractor for the SRTR. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the SRTR or U.S. government.
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: firstname.lastname@example.org