Table 1 Summary of studies included in scoping review
First author (publication year) | Study year | Population, setting | Sample size | Outcome | Method category1 | Unadjusted findings | Adjusted findings |
|---|---|---|---|---|---|---|---|
Soucie (1992) | 1989–1990 | Black and White patients on dialysis; North Carolina, South Carolina, Georgia | 8,315 (53% female, 32% White, 68% Black) | Transplant candidacy | Categorized intersectional position | Unadjusted candidacy rates White men: 16.7% White women: 13.7% Black men: 18.4% Black women: 13.1% | Adjusted odds ratios2 White men: referent White women: 0.88 (95% CI 0.65–1.18) Black men: 0.77 (0.59–0.99) Black women: 0.66 (0.51–0.87) |
Ojo (1993) | 1983–1990 | Black and White ESKD patients; United States | Not reported | Living related donor (LRD) transplantation rate | Stratification | Unadjusted (transplantation rates) 1983 White men 4x higher transplantation rate than Black men White women 4x Black women Black men 1.2x Black women White men 1.34x White women 1990 White men 5x Black men White women 4x Black women Black men 1x Black women White men 1.2x White women | NR |
Narva (1996) | 1990 | Native American and White patients on dialysis or received a transplant; Arizona and New Mexico | 8,851 (46% female, 18% Native American, 82% White) | Transplantation rate | Raw data | Unadjusted risk ratios3 Arizona Native American men: referent White men: 1.06 (0.85–1.32) Native American women: referent White women 1.90 (1.39–2.61) New Mexico Native American men: referent White men 1.53 (1.09–2.14) Native American women: referent White women: 1.96 (1.32–2.89) | NR |
McCauley (1997) | 1990–1992 | Black and White women initiating dialysis; Pennsylvania | 276 (38% White, 62% Black) | Referral for transplantation; transplantation | Stratification (intra-categorical analysis) | Unadjusted risk ratios4 Referral Black women: referent White women 0.98 (0.79–1.23) Transplantation Black women: referent White women 1.60 (1.04–2.48) Time to referral White women: 1.37 ± 0.24 years vs. Black women: 2.19 ± 0.3 years (p = 0.001) | Adjusted risk ratios5 Referral Race not associated with referral (data not shown) Transplantation Black women: referent White women: 2.2 (95% CI 1.3-4.0) |
Ayanian (1999) | 1996–1997 | Black and White patients initiating dialysis; Alabama, California, Michigan, Maryland, Virginia, Washington DC | 1,392 (53% female, 48% White, 52% Black) | Referral; waitlisting or transplantation within 18 months of dialysis initiation; preference for kidney transplantation | Categorized intersectional position | Unadjusted probability of the outcome Referral White men: 82.3% vs. Black men: 60.4% (p < 0.001) White women: 75.2% vs. Black women: 55.5% (p < 0.001) Waitlisting or transplantation White men: 70.8% vs. Black men: 45.4% (p < 0.001) White women: 71.4% vs. Black women: 44.2% (p < 0.001) Desire kidney transplant White men: 85.5% vs. Black men: 80.7% (p = 0.04) White women: 79.3% vs. Black women: 76.3% (p = 0.13) | Adjusted probability of the outcome6 Referral White men: 78.2% (referent) White women: 75.1% (95% CI 65.4–82.9) Black men: 61.2% (49.8–71.5) Black women: 59.9% (48.2–70.6) Waitlisting or transplantation White men: 62.7% (referent) White women: 64.7% (54.3–73.8) Black men: 48.7% (37.9–59.6) Black women: 44.6% (33.7–55.8) |
Epstein (2000) | 1996–1997 | Black and White patients initiating dialysis; Alabama, California, Michigan, Maryland, Virginia, Washington DC | 1,518 (52% female, 48% White, 52% Black) | Referral7; waitlisting; transplantation | Stratification | Unadjusted Referral – appropriate candidates White men: 98.8% vs. Black men: 86.5% (p = 0.005) White women: 97.2% vs. Black women: 94.1% (p = 0.43) Referral – inappropriate candidates White men: 62.7% vs. Black men: 36.6% (p < 0.001) White women: 53.9% vs. Black women: 40.0% (p = 0.02) Waitlisting – appropriate candidates White men: 90.3% vs. Black men: 61.1% (p < 0.001) White women: 82.5% vs. Black women: 81.8% (p = 0.93) Waitlisting – inappropriate candidates White men: 33.0% vs. Black men: 19.3% (p = 0.01) White women: 29.2% vs. Black women: 15.8% (p = 0.005) Transplantation – appropriate candidates White men: 58.8% vs. Black men: 16.2% (p < 0.001) White women: 44.4% vs. Black women: 17.7% (p = 0.007) Transplantation – inappropriate candidates White men: 10.8% vs. Black men: 3.4% (p = 0.02) White women: 9.9% vs. Black women: 1.2% (p < 0.001) | Adjusted8 Referral – appropriate candidates White men: 96.0% vs. Black men: 90.9% (p = 0.57) White women: 96.1% vs. Black women: 93.1% (p = 0.60) Referral – inappropriate candidates White men: 67.7% vs. Black men: 36.4% (p = 0.013) White women: 58.8% vs. Black women: 43.1% (p = 0.21) Waitlisting – appropriate candidates White men: 85.9% vs. Black men: 68.7% (p = 0.12) White women: 82.4% vs. Black women: 85.6% (p = 0.49) Waitlisting – inappropriate candidates White men: 37.8% vs. Black men: 20.9% (p = 0.20) White women: 34.7% vs. Black women: 19.1% (p = 0.07) Transplantation – appropriate candidates White men: 62.2% vs. Black men: 16.4% (p = 0.002) White women: 41.0% vs. Black women: 18.8% (p = 0.14) Transplantation – inappropriate candidates White men: 22.8% vs. Black men: 6.0% (p = 0.04) White women: 23.5% vs. Black women: 1.5% (p = 0.01) |
Thamer (2001) | 1997–1998 | Nephrologists; United States | 271 | Recommendation for kidney transplantation | Categorized intersectional position | Unadjusted odds ratios White men: referent White women: 0.50 (CI 0.38–0.65) Black women: 0.84 (0.65–1.08) Asian men: 0.61 (0.45–0.79) | Adjusted odds ratios9 White men: referent White women: 0.41 (0.21–0.79) Black women: 0.78 (0.53–1.16) Asian men: 0.46 (0.24–0.91) No statistically significant difference between White women and Black women (results not shown) |
Klassen (2002) | 1996–1997 | Black and White patients eligible for kidney transplant; Maryland | 114 (44% female, 29% White, 71% Black) | Waitlisting | Regression with interaction term; stratification | NR | Adjusted10 “African American and White men were both more likely to be listed than female patients; the sex effect was consistent across racial groups, and there was not a significant interaction effect between race and sex” (data not shown). |
Clark (2008) | 1996–1997 | Black and White patients initiating dialysis; Alabama, California, Michigan, Maryland, Virginia, Washington DC | 742 (50% female, 50% White, 50% Black) | Preference for transplant; physician recommendation for transplant11 | Stratification | Unadjusted odds ratios12 Preference for transplant White men: referent vs. Black men: 0.42 (CI 0.22–0.80) White women: referent vs. Black women: 0.92 (0.54–1.58) Recommendation for transplant White men: referent vs. Black men: 0.55 (0.33–0.93) White women: referent vs. Black women: 0.58 (0.35–0.94) | NR |
Weng (2010) | 2000–2005 | Patients evaluated for kidney transplant; New Jersey | 1,617 (39% female, 74% “non-Black,” 26% Black) | Recruitment of living kidney donors; receipt of living donor kidney transplant | Regression with interaction term | NR | Adjusted13 No statistically significant interactions between race and sex (results not shown) |
Gillespie (2014) | 2008–2009 | Black patients with ESKD on chronic hemodialysis; Pennsylvania | 101 (52% female) | Waitlisting; evaluation for transplant; views on transplantation | Stratification (intra-categorical analysis) | Unadjusted odds ratio14 Waitlisting Black men: referent vs. Black women: 0.51 (CI 0.20–1.28) Evaluation Black men: referent vs. Black women: 0.35 (0.15–0.80) Would accept LDKT Black men: referent vs. Black women: 0.28 (0.09–0.88) Would accept DDKT Black men: referent vs. Black women: 0.11 (0.02–0.54) | Adjusted odds ratio15 Would accept LDKT Black men: referent vs. Black women: 0.15 (CI 0.04–0.46)16 |
Monson (2015) | 2009–2010 | Patients presenting for initial kidney transplant evaluation; Illinois | 256 (43% female, 22% White, 50% Black, 29% Hispanic) | Rate of completion of pre-transplant evaluation within 12 months of initial renal transplant clinic visit | Regression with interaction term; categorized intersectional position | NR | Adjusted hazard ratios17 Black men: referent vs. Black women: 1.38 (p = 0.16) White men: 1.99 (p = 0.005) White women: 0.94 (p = 0.83) Hispanic men: 2.75 (p < 0.0001) Hispanic women: 1.96 (p = 0.006) Statistically significant interaction between race/ethnicity and sex on completion (p = 0.02) White women: referent vs. Black women: 1.80 (p = 0.08) Hispanic women: 2.18 (p = 0.02) |
Gillespie (2020) | 2012–2014 | Patients waitlisted for kidney transplant; Virginia | 128 (53% female, 32% White, 68% Black) | Number of living donor requests | Stratification | NR | Adjusted incidence rate ratios18 White men: referent vs. White women: 3.06 (CI 1.43–6.55) Black men: referent vs. Black women: 1.62 (0.98–2.67) |
Smothers (2022) | 2012–2016 | ESKD patients initiating dialysis; North Carolina, South Carolina, Georgia | 45,015 (45% female, 42% White, 53% Black, 3% Hispanic, 2% “Other” race) | Referral | Regression with interaction term; stratification | NR | Adjusted odds ratios19 White men: referent vs. White women: 0.76 (CI 0.71–0.82) Black men: referent vs. Black women: 0.93 (0.88–0.99) Hispanic men: referent vs. Hispanic women: 0.85 (0.65–1.12) “Other race” men: referent vs. “Other race” women: 0.78 (0.56–1.09) There was a statistically significant interaction between race and sex (p = 0.001) |