Beginning January 1, 2000, Medicare effectively extended its coverage of immunosuppression medications from 3 years to lifetime for patients eligible for Medicare on the basis of age or disability status. We examined the impact of this policy on racial disparities in kidney transplant outcomes at 5 years. Using data from the US Renal Data System, we identified cohorts of Medicare-insured kidney transplant recipients according to patient characteristics defining eligibility for lifetime immunosuppression coverage according to the year 2000 policy. We compared racial disparities in graft survival among those eligible for lifetime coverage with the Kaplan–Meier method. We modeled adjusted associations of patient race, patient income, benefits eligibility category and policy exposure with graft loss by multivariable Cox's regression. The racial disparity in graft survival between African American and non-African American among transplant recipients eligible for the lifetime benefit persisted. The graft survival disparity between high- and low-income African American recipients was insignificantly reduced among those eligible for the lifetime benefit. The results of the study suggest that insurance coverage of medication did not eliminate or reduce the racial disparity in graft survival.
Sociocultural and socioeconomic disparities in graft survival, graft function, and patient survival in adult kidney transplant recipients are reviewed. Studies consistently document worse outcomes for black patients, patients with low income, and patients with less education, whereas better outco...
Chronic kidney disease is more common in Black race, which is overrepresented among the US hemodialysis patients and which is associated with more severe secondary hyperparathyroidism but greater survival compared to non-Black race. We hypothesized that Mineral and Bone Disorders (MBD) have a bea...
Success of renal transplantation, as a viable alternative to dialysis, has been tempered by long-standing racial disparities. Ethnic minorities have less access to transplantation, are less likely to be listed for transplantation, and experience a higher rate of graft failure. Reasons for the exi...
To systematically evaluate the clinical consequences ofmycophenolate dose reduction in renal transplant recipients ontacrolimus-based regimens.DATA SOURCES: PubMed (1949-July 2010), EMBASE (1980-July 2010),Cochrane Database of Systematic Reviews, International Pharmaceuticals, and Web of Science ...
We examined the effect of Medicare's expansion of colorectal cancer (CRC) screening test reimbursement on racial/ethnic disparities in CRC screening. CRC screening was ascertained for Medicare beneficiaries (n = 30,893), aged 70 to 89, who had no history of any tumor and resided in 16 Surveillanc...
We studied the impact of steroid use on kidney graft loss due to recurrent IgA nephropathy (IgAN). We used data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) to conduct a survival analysis of adult recipients of a first kidney transplant for IgAN who received a gra...
Posttransplant lymphoproliferative disorder (PTLD) is a major complication of kidney transplant.Study DesignRetrospective cohort study comparing PTLD incidence rates using US Medicare claims and Organ Procurement and Transplantation Network (OPTN) data, examining risk factors for PTLD in OPTN dat...
Long-term renal graft survival is hampered by allograft dysfunction and cardiovascular disease resulting from calcineurin inhibitors (CNIs). This has led to the development of immunosuppressive regimens involving mammalian target of rapamaycin (mTOR) inhibitors, sirolimus and everolimus. They see...
Racial and ethnic disparities among North American patients with chronic kidney disease have received significant attention. In contrast, little is known about health-related outcomes of patients with end-stage renal disease among the Roma minority, also known as gypsies, compared to Caucasian in...
Education services for Stage-IV chronic kidney disease patients were added in 2010 as a Part B covered benefit under the Medicare Improvements for Patients and Providers Act. Desired outcomes include early pursuit of kidney transplantation by more patients and reduction of racial disparities in a...
