Dr. Patzer Lead Author on Two Racial Disparities Studies

February 2012

Dr. Rachel Patzer was the lead author on a research paper that showed racial disparities and poverty hinder access to health care in both the early and later stages of transplantation. The study, "The Role of Race and Poverty on Steps to Kidney Transplantation in the Southeastern United States," was published in the February edition of the American Journal of Transplantation.

The study found that when adjusted for demographic, clinical, and socioeconomic factors, black patients had a 59% lower rate of transplantation over that of white patients. It examined 2,291 patients, nearly two-thirds of whom were black and a third lived in low-income areas, to determine the effect of race on referral, evaluation, wait-listing, and organ transplantation. The patients were referred for Emory kidney transplant evaluations from 2005 to 2007 and were followed through 2010.

"Despite near-universal health care coverage for end-stage renal disease (ESRD) patients through the Medicare ESRD program, black ESRD patients are at a disadvantage to receive kidney transplantation," Dr. Patzer reports. "Socioeconomic status really accounts for about 30% of this observed racial disparity in transplant access. Further research is needed to identify what may be explaining the racial disparities that still exist in access to kidney transplantation."

The study had support from Emory's Race and Difference Initiative. Dr. Jennie Perryman, director of policy and outcomes management for the Emory Transplant Center (ETC), and Dr. Stephen Pastan, medical director of the ETC's kidney transplant program, also worked on the study.

In a separate study, "Impact of a Patient Education Program on Disparities in Kidney Transplant Evaluation," Dr. Patzer and her colleagues, including Drs. Perryman and Pastan, found that patient education may help reduce racial disparities in ESRD patients who need transplantation. They published their findings online on Feb. 16 ahead of print publication in the Clinical Journal American Society of Nephrology.

In 2007, the ETC created a mandatory education session for each ESRD patient referred for a kidney transplant evaluation. The half-day class provided patients with lectures and discussions with a transplant coordinator, financial coordinator, and social worker. The study examined data of 1,126 patients referred for evaluations from 2005 to 2008.

The data showed that 80% of patients who attended the session were evaluated within a year, while only 45% of patients seen before the class existed were evaluated in a year. In addition, the study found that the session particularly helped black patients and those who lived in poor neighborhoods to complete an evaluation within a year.

This study may help provide guidelines for transplant centers to use educational programs to improve access for impoverished and black patients.