Racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation

Abstract Background Racial/ethnic disparities in living donor kidney transplantation (LDKT) are large, and rates of LDKT may be limited by indirect costs of living donation. A 2019 Executive Order– Advancing American Kidney Health (AAKH)– sought to remove indirect costs through an expanded reimburse...

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Autores principales:	Selena E. Ortiz, Ashton M. Verdery, Jonathan Daw
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Health policy Health disparities Kidney transplantation Racial/ethnic minorities Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/1c9ce3532b1d422a91183fe598f08efd
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spelling	oai:doaj.org-article:1c9ce3532b1d422a91183fe598f08efd2021-11-08T10:43:47ZRacial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation10.1186/s12889-021-12023-w1471-2458https://doaj.org/article/1c9ce3532b1d422a91183fe598f08efd2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12023-whttps://doaj.org/toc/1471-2458Abstract Background Racial/ethnic disparities in living donor kidney transplantation (LDKT) are large, and rates of LDKT may be limited by indirect costs of living donation. A 2019 Executive Order– Advancing American Kidney Health (AAKH)– sought to remove indirect costs through an expanded reimbursement program. We examine how potential living kidney donors in the U.S. believe regulation stemming from the AAKH initiative will impact their living donor evaluation likelihood, how these beliefs vary by minority race/ethnicity and prior willingness to be evaluated, and how differences are explained by ability to benefit or knowledge and attitudes. Methods Data from a 2019 online survey (Families of Renal Patients Survey) were used. Respondents are U.S. adult (> 18 years) members of the Qualtrics Survey Panel who reported having relatives with weak or failing kidneys (N = 590). Respondents’ likelihood to be evaluated for living kidney donation are measured by self-report. Prior willingness is measured by past donation-related actions and current attitudes. Ability to benefit is measured by self-reported labor force participation and financial strain. Transplant knowledge is measured by self-report and a knowledge test, and transplant-related attitudes are measured by self-report. Average marginal effects of minority race/ethnicity and prior willingness for response to each provision in fully-adjusted models were estimated. Formal tests of mediation were conducted using the Karlson, Holm, and Breen (KHB) mediation model. Stata/MP 14.2 was used to conduct all analyses. Results Majorities of all groups report favorable responses to the provisions stipulated in AAKH regulation. Responses to provisions are significantly associated with race/ethnicity and prior willingness, with racial/ethnic minorities and those not previously willing to be evaluated less likely to report favorable responses to these provisions. Prior willingness differences are partially explained by group differences in ability to benefit and transplant-related knowledge and attitudes, but racial/ethnic differences largely are not. Conclusions Regulation stemming from the AAKH initiative is likely to effectively promote LDKT, but may also exacerbate racial/ethnic disparities. Therefore, the regulation may need to be supplemented by efforts to address non-financial obstacles to LDKT in racial/ethnic minority communities in order to ensure equitable increases in LDKT rates and living donor support.Selena E. OrtizAshton M. VerderyJonathan DawBMCarticleHealth policyHealth disparitiesKidney transplantationRacial/ethnic minoritiesPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Health policy Health disparities Kidney transplantation Racial/ethnic minorities Public aspects of medicine RA1-1270
spellingShingle	Health policy Health disparities Kidney transplantation Racial/ethnic minorities Public aspects of medicine RA1-1270 Selena E. Ortiz Ashton M. Verdery Jonathan Daw Racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation
description	Abstract Background Racial/ethnic disparities in living donor kidney transplantation (LDKT) are large, and rates of LDKT may be limited by indirect costs of living donation. A 2019 Executive Order– Advancing American Kidney Health (AAKH)– sought to remove indirect costs through an expanded reimbursement program. We examine how potential living kidney donors in the U.S. believe regulation stemming from the AAKH initiative will impact their living donor evaluation likelihood, how these beliefs vary by minority race/ethnicity and prior willingness to be evaluated, and how differences are explained by ability to benefit or knowledge and attitudes. Methods Data from a 2019 online survey (Families of Renal Patients Survey) were used. Respondents are U.S. adult (> 18 years) members of the Qualtrics Survey Panel who reported having relatives with weak or failing kidneys (N = 590). Respondents’ likelihood to be evaluated for living kidney donation are measured by self-report. Prior willingness is measured by past donation-related actions and current attitudes. Ability to benefit is measured by self-reported labor force participation and financial strain. Transplant knowledge is measured by self-report and a knowledge test, and transplant-related attitudes are measured by self-report. Average marginal effects of minority race/ethnicity and prior willingness for response to each provision in fully-adjusted models were estimated. Formal tests of mediation were conducted using the Karlson, Holm, and Breen (KHB) mediation model. Stata/MP 14.2 was used to conduct all analyses. Results Majorities of all groups report favorable responses to the provisions stipulated in AAKH regulation. Responses to provisions are significantly associated with race/ethnicity and prior willingness, with racial/ethnic minorities and those not previously willing to be evaluated less likely to report favorable responses to these provisions. Prior willingness differences are partially explained by group differences in ability to benefit and transplant-related knowledge and attitudes, but racial/ethnic differences largely are not. Conclusions Regulation stemming from the AAKH initiative is likely to effectively promote LDKT, but may also exacerbate racial/ethnic disparities. Therefore, the regulation may need to be supplemented by efforts to address non-financial obstacles to LDKT in racial/ethnic minority communities in order to ensure equitable increases in LDKT rates and living donor support.
format	article
author	Selena E. Ortiz Ashton M. Verdery Jonathan Daw
author_facet	Selena E. Ortiz Ashton M. Verdery Jonathan Daw
author_sort	Selena E. Ortiz
title	Racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation
title_short	Racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation
title_full	Racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation
title_fullStr	Racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation
title_full_unstemmed	Racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation
title_sort	racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing american kidney health regulation
publisher	BMC
publishDate	2021
url	https://doaj.org/article/1c9ce3532b1d422a91183fe598f08efd
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Racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation

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