Racial Disparities in Hospitalization Rates During Long-Term Follow-Up After Deceased-Donor Kidney Transplantation.

Area of Science:

• Nephrology
• Transplantation Immunology
• Health Disparities Research

Background:

• Kidney transplantation is a critical treatment for end-stage renal disease.
• Understanding post-transplant outcomes, including hospitalization, is vital for patient care.
• Racial disparities in healthcare access and outcomes persist in solid organ transplantation.

Purpose of the Study:

• To compare hospitalization rates between African American (AA) and European American (EA) deceased-donor kidney transplant recipients over a decade.
• To investigate the influence of social determinants of health (SDoH) on these disparities.

Main Methods:

• Utilized data from the Scientific Registry of Transplant Recipients and the Social Deprivation Index for SDoH.
• Analyzed hospitalization rates in four donor/recipient pair (DRP) groups: AA/AA, AA/EA, EA/AA, and EA/EA.
• Employed Poisson-Gamma models to assess post-transplant hospitalizations.

Main Results:

• Unadjusted hospitalization rates were higher for all DRPs involving AA donors or recipients compared to EA/EA pairs.
• Multivariable analysis revealed U-shaped relationships between SDoH and hospitalizations, varying by recipient race.
• AA recipients in areas with the worst SDoH and EA recipients in areas with the best SDoH showed increased hospitalization rates.

Conclusions:

• The association between healthcare utilization and SDoH is complex and depends on the donor/recipient pair's racial combination.
• Higher hospitalization rates were observed in AA recipients in high SDoH-deprived areas and EA recipients in low SDoH-deprived areas.
• SDoH significantly contributes to disparities in post-kidney transplant hospitalizations.