hborhoods historically influenced by racial segregation have reduced access to health care. Whether this is true for individuals with ESKD seeking transplant is unknown. Methods We identified Black or White adults (N=42,401; 18–80 years) with ESKD initiating KRT in three US states (Georgia, North Carolina, South Carolina) between January 2015 and December 2019, with follow-up through 2020, from the United States Renal Data System. Residential segregation was defined using the racial Index of Concentration at the Extremes and classified into tertiles (predominantly Black, mixed, or predominantly White neighborhoods). Primary outcomes were referral within 12 months of KRT initiation (among individuals initiating KRT) and evaluation within 6 months of referral (among all referred individuals), determined by linkage of the United States Renal Data System to the Early Steps to Transplant Access Registry. Secondary outcomes included waitlisting (among evaluated individuals) and living or deceased donor transplant (among waitlisted individuals). The association between residential segregation and each outcome was assessed using multivariable Cox models with robust sandwich variance estimators. Results In models adjusted for clinical factors, individuals living in predominantly Black or mixed (versus predominantly White) neighborhoods were 8% (adjusted hazard ratio [aHR], 0.92 [0.88 to 0.96]) and 5% (aHR, 0.95 [0.91 to 0.99]) less likely to be referred for a kidney transplant, 18% (aHR, 0.82 [0.76 to 0.90]) and 9% (aHR, 0.91 [0.84 to 0.98]) less likely to be waitlisted among those who started evaluation, and 54% (aHR, 0.46 [0.36 to 0.58]) and 24% (aHR, 0.76 [0.63 to 0.93]) less likely to receive a living donor kidney transplant among those who were waitlisted, respectively. For other transplant steps, associations were nonsignificant. Conclusions Individuals with ESKD living in historically and currently marginalized communities in the Southeast United States have reduced access to important steps along the transplant care continuum....

中文翻译：

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住宅隔离与获得肾移植之间的关联：来自多州队列研究的证据


历史上受种族隔离影响的 HBORHOODS 减少了获得医疗保健的机会。对于寻求移植的 ESKD 个体来说，这是否属实尚不清楚。方法 我们确定了 2015 年 1 月至 2019 年 12 月期间在美国三个州（佐治亚州、北卡罗来纳州、南卡罗来纳州）启动 KRT 的黑人或白人成年人 （N=42,401;18-80 岁），随访至 2020 年，来自美国肾脏数据系统。住宅隔离是使用极端种族集中指数定义的，并分为三级（主要是黑人、混合或以白人为主的社区）。主要结局是 KRT 开始后 12 个月内的转诊 （在开始 KRT 的个体中） 和转诊后 6 个月内的评估 （在所有转诊个体中），通过美国肾脏数据系统与移植通路登记早期步骤的联系确定。次要结局包括等待名单 （在评估个体中） 和活体或已故供体移植 （在等待名单上的个体中）。使用具有稳健夹心方差估计器的多变量 Cox 模型评估住宅隔离与每个结果之间的关联。结果在根据临床因素调整的模型中，居住在以黑人为主或混合（与以白人为主）社区的个体在开始评估的人群中被转诊为肾移植的可能性降低 8%（调整后的风险比 [aHR]，0.92 [0.88 至 0.96]）和 5%（aHR，0.95 [0.91 至 0.99]），在开始评估的人群中被列入候补名单的可能性降低 18%（aHR，0.82 [0.76 至 0.90]）和 9%（aHR，0.91 [0.84 至 0.98]）。 在候补名单中，接受活体供体肾移植的可能性分别降低了 54%（aHR，0.46 [0.36 至 0.58]）和 24%（aHR，0.76 [0.63 至 0.93]）。 对于其他移植步骤，关联不显著。结论 生活在美国东南部历史上和目前边缘化社区的 ESKD 患者获得移植护理连续体中重要步骤的机会减少。