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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 8 of 8 Research Studies DisplayedStrauss AT, Sidoti CN, Purnell TS
Multicenter study of racial and ethnic inequities in liver transplantation evaluation: understanding mechanisms and identifying solutions.
This multicenter study examined racial and ethnic inequities in liver transplantation. The authors recruited participants from the liver transplantation (LT) teams including coordinators, advanced practice providers, physicians, social workers, dieticians, pharmacists, leadership at 2 major LT centers. They conducted 54 interviews and had 49 observation hours. They created a conceptual framework describing how transplant work system characteristics and other external factors may improve equity in the LT evaluation process. They proposed transplant center-level solutions (i.e., including but not limited to training of staff on health equity) to modifiable barriers in the clinical work system that could help patient navigation, reduce disparities, and improve access to care. Their findings call for an urgent need for transplant centers, national societies, and policy makers to focus efforts on improving equity (tailored, patient-centered resources) using the science of human factors and systems engineering.
AHRQ-funded; HS024600.
Citation: Strauss AT, Sidoti CN, Purnell TS .
Multicenter study of racial and ethnic inequities in liver transplantation evaluation: understanding mechanisms and identifying solutions.
Liver Transpl 2022 Dec;28(12):1841-56. doi: 10.1002/lt.26532..
Keywords: Racial and Ethnic Minorities, Transplantation, Disparities, Access to Care
Butler T, Cummings LS, Purnell TS
The case for prioritizing diversity in the transplantation workforce to advance kidney health equity.
The authors of this article propose a more diverse transplant workforce to address the problem of kidney transplant inequity. Black patients are disproportionately affected by kidney failure and systemic barriers to kidney transplantation such as delayed referrals, which may be due to clinician bias. Workforce diversity would help to alleviate the harm of implicit biases.
AHRQ-funded; HS024600.
Citation: Butler T, Cummings LS, Purnell TS .
The case for prioritizing diversity in the transplantation workforce to advance kidney health equity.
J Am Soc Nephrol 2022 Oct; 33(10):1817-19. doi: 10.1681/asn.2022040429..
Keywords: Kidney Disease and Health, Transplantation, Workforce, Disparities, Racial and Ethnic Minorities
Alvarado F, Cervantes CE, Crews DC
Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: a systematic review.
The purpose of this systematic qualitative review was to evaluate outcomes in Hispanic donors and examine how Hispanic ethnicity was presented. In October 2021, the researchers reviewed PubMed, EMBASE, and Scopus for studies, with 18 meeting the inclusion criteria. Across the studies, Hispanic donors ranged between 6% and 21% of the donor populations. The study found that Hispanic donors were not at increased risk for end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, overall perioperative surgical complications or post-donation mortality compared to non-Hispanic White donors. Also compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were observed regarding the risk for post-donation chronic kidney disease and hypertension. The researchers concluded that future studies should explain variation in health outcomes by considering and assessing differences within the Hispanic donor population.
AHRQ-funded; HS024600.
Citation: Alvarado F, Cervantes CE, Crews DC .
Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: a systematic review.
Am J Transplant 2022 Jul;22(7):1737-53. doi: 10.1111/ajt.17017..
Keywords: Transplantation, Kidney Disease and Health, Chronic Conditions, Racial and Ethnic Minorities, Disparities
Krissberg JR, Kaufmann MB, Gupta A
Racial disparities in pediatric kidney transplantation under the new Kidney Allocation System in the United States.
This study aimed to assess how implementation of the 2014 Kidney Allocation System (KAS) affected racial and ethnic disparities in pediatric kidney transplantation access and related outcomes. The authors performed a retrospective cohort study of children <18 years of age active on the kidney transplant list from 2008 to 2019 using the Scientific Registry of Transplant Recipients. Results found that all children experienced longer wait times from activation to transplantation post-KAS. Although they found that Black and Hispanic children and other children of color experienced longer times from activation to transplant compared with White children in both eras; this finding was largely attenuated after multivariable analysis. Multivariable analysis also showed that racial and ethnic disparities in time from dialysis initiation to transplantation in the pre-KAS era were lessened in the post-KAS era. No disparities were found in odds of delayed graft function, however Black and Hispanic children experienced longer times with a functioning graft in the post-KAS era.
AHRQ-funded; HS026128.
Citation: Krissberg JR, Kaufmann MB, Gupta A .
Racial disparities in pediatric kidney transplantation under the new Kidney Allocation System in the United States.
Clin J Am Soc Nephrol 2021 Dec; 16(12):1862-71. doi: 10.2215/cjn.06740521..
Keywords: Disparities, Racial and Ethnic Minorities, Kidney Disease and Health, Transplantation
Purnell TS, Simpson DC, Callender CO
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
As the United States faces unparalleled challenges due to COVID-19, racial disparities in health and healthcare have once again taken center stage. If effective interventions to address racial disparities in transplantation, including those magnified by COVID-19, are to be designed and implemented at the national level, it is first critical to understand the complex mechanisms by which structural, institutional, interpersonal, and internalized racism influence the presence of racial disparities in healthcare and transplantation. IN this article the authors discuss their viewpoint.
AHRQ-funded; HS024600.
Citation: Purnell TS, Simpson DC, Callender CO .
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
Am J Transplant 2021 Jul;21(7):2327-32. doi: 10.1111/ajt.16543..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Transplantation, Surgery, Access to Care
Kumar K, Tonascia JM, Muzaale AD
Racial differences in completion of the living kidney donor evaluation process.
Racial disparities in living donor kidney transplantation (LDKT) persist, but the most effective target to eliminate these disparities remains unknown. The researchers investigated delays during completion of the live donor evaluation process. They concluded that delays may be a manifestation of the transplant candidate's social network and recommended targeted efforts to optimize networks for identification of donor candidates in order to address LDKT disparities.
AHRQ-funded; HS024600.
Citation: Kumar K, Tonascia JM, Muzaale AD .
Racial differences in completion of the living kidney donor evaluation process.
Clin Transplant 2018 Jul;32(7):e13291. doi: 10.1111/ctr.13291..
Keywords: Transplantation, Racial and Ethnic Minorities, Disparities, Kidney Disease and Health
Purnell TS, Luo X, Cooper LA
Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014.
This study estimated changes over time in racial/ethnic disparities in live donor kidney transplantation (LDKT) in the United States, accounting for differences in death and deceased donor kidney transplantation. Among adult first-time kidney transplantation candidates in the United States who were added to the deceased donor kidney transplantation waiting list between 1995 and 2014, disparities in the receipt of live donor kidney transplantation increased from 1995-1999 to 2010-2014.
AHRQ-funded; HS024600.
Citation: Purnell TS, Luo X, Cooper LA .
Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014.
JAMA 2018 Jan 2;319(1):49-61. doi: 10.1001/jama.2017.19152.
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Keywords: Disparities, Kidney Disease and Health, Kidney Disease and Health, Racial and Ethnic Minorities, Transplantation
Kumar K, Holscher CM, Luo X
Persistent regional and racial disparities in nondirected living kidney donation.
Nondirected living donors (NDLDs) are an important and growing source of kidneys to help reduce the organ shortage. The authors of this study hypothesized that the initial geographic clustering and racial disparities may have improved due to an increase in NDLDs. The authors found that despite the increased number of NDLDs, racial disparities have worsened and the center-level distribution of NDLD transplants has narrowed in recent years.
AHRQ-funded; HS024600.
Citation: Kumar K, Holscher CM, Luo X .
Persistent regional and racial disparities in nondirected living kidney donation.
Clin Transplant 2017 Dec;31(12). doi: 10.1111/ctr.13135..
Keywords: Disparities, Health Services Research (HSR), Policy, Transplantation, Racial and Ethnic Minorities