Background In the United States, black patients undergo renaltransplantation less often than white patients, but few studieshave directly assessed the association between race and patients'preferences with respect to transplantation.
Methods To assess preferences with respect to transplantationand experiences with medical care, we interviewed 1392 (82.9percent) of 1679 eligible patients with end-stage renal disease(age range, 18 to 54 years) approximately 10 months after theyhad begun maintenance treatment with dialysis. Participantswere selected from a stratified random sample of patients undergoingdialysis in four regions of the United States (Alabama, southernCalifornia, Michigan, and the mid-Atlantic region of Maryland,Virginia, and the District of Columbia) in 1996 and 1997. Patientswere followed until March 1999.
Results The interviews were conducted with 384 black women,354 white women, 337 black men, and 317 white men. Black patientswere less likely than white patients to want a transplant (76.3percent of black women reported such a preference, vs. 79.3percent of white women, and 80.7 percent of black men vs. 85.5percent of white men), and they were less likely to be verycertain about this preference (58.3 percent vs. 65.3 percentand 64.1 percent vs. 75.7 percent, respectively; P<0.01 foreach comparison with both sexes combined). However, much largerdifferences were evident in rates of referral for evaluationat a transplantation center (50.4 percent for black women vs.70.5 percent for white women, and 53.9 percent for black menvs. 76.2 percent for white men; P<0.001 for each comparison)and placement on a waiting list or transplantation within 18months after the start of dialysis therapy (31.3 percent forblack women vs. 56.5 percent for white women, and 35.3 percentfor black men vs. 60.6 percent for white men; P<0.001). Theseracial differences remained significant after adjustment forpatients' preferences and expectations about transplantation,sociodemographic characteristics, the type of dialysis facility,perceptions of care, health status, the cause of renal failure,and the presence or absence of coexisting illnesses.
Conclusions In the United States, the preferences and expectationswith respect to renal transplantation among patients with end-stagerenal disease differ according to race. These differences, however,explain only a small fraction of the substantial racial differencesin access to transplantation. Physicians should ensure thatblack patients who desire renal transplantation are fully informedabout it and are referred for evaluation.
Source Information
From the Department of Medicine, Division of General Medicine and Primary Care, Section on Health Services and Policy Research, Brigham and Women's Hospital and Harvard Medical School (J.Z.A., A.M.E.); the Department of Health Care Policy, Harvard Medical School (J.Z.A., P.D.C., J.S.W.); the Institute for Health Policy, Massachusetts General Hospital (J.S.W.); and the Department of Health Policy and Management, Harvard School of Public Health (A.M.E.) — all in Boston.
Address reprint requests to Dr. Ayanian at the Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, or at ayanian{at}hcp.med.harvard.edu.
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