Health Disparities
Disaggregating the Asian Racial Category on the Kidney Transplant Waiting List Jesse Howell* Jesse Howell Oscar K. Serrano Alejandro Diaz
Purpose: The Organ Procurement and Transplantation Network (OPTN) reports race/ethnicity in aggregate, which simplifies reporting but lacks granularity. This analysis evaluates the Asian, non-Hispanic (NH) category according to geographic subgroups to assess for geographic and ethnic disparities in this population.
Methods: We analyzed Asian, NH kidney registrations on the OPTN waiting list (WL) between 7/1/2022-6/30/2024 using race/ethnicity data from the Transplant Candidate Registration Form. We calculated dialysis time at listing by taking the difference between the dialysis start date and the WL registration date, and demographic factors using counts and percentages. We estimated one-year graft survival using Kaplan Meier for those transplanted between 7/1/2022-6/30/2023.
Results: There were 15,868 registrations in the WL cohort. The largest group was Asian: Not Specified/Unknown (n=4,302) followed by Filipino (n=3,518), and Asian Indian/Indian Sub-Continent (AIIS) (n=2,492). Most Asian, NH candidates were listed in OPTN Region 5 (42%), but only 23% of AIIS candidates were listed in this region compared to 67% of Filipino candidates. AIIS candidates were more likely to have a post-college graduate degree compared to the WL cohort (27% vs 14%), while the Vietnamese group was more likely to have a level of education of grade school or less (15% vs. 8.1%). The median dialysis time at listing for Asian, NH candidates was 164 days, ranging from 65 for the AIIS group to 235 for the Korean group. One-year graft survival estimates were not significantly different and ranged from .91 to .97.
Conclusion: There were differences in all factors evaluated, with the most impactful being OPTN Region, education, and dialysis time at listing. This may be indicative of varying access for certain Asian, NH candidates, though graft survival was similar. Where numbers allow, racial/ethnic groups should be disaggregated to evaluate for differences in access in diverse populations.
