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Has the United States Eliminated Income and Racial Differences?

Philip J. Held, PhD; Mark V. Pauly, PhD; Randall R. Bovbjerg, JD; John Newmann, PhD; Oscar Salvatierra, Jr, MD

Arch Intern Med. 1988;148(12):2594-2600.

Abstract
• We analyzed the effect of patient and dialysis unit characteristics on access to kidney transplantation using several different approaches, including an analysis of individual patient data from a systematic random sample of 2900 new dialysis patients from each year 1981 to 1985 (14721 patients total). Additional analyses focused on the composition of transplant waiting lists and aggregate data from a 1984 census of 1133 dialysis and transplant units. White, male, young, nondiabetic, high-income patients treated in smaller units are more likely to receive a cadaver transplant under Medicare than are other kidney patients. Profit status of the dialysis unit was not found to be correlated to access to transplantation, although size of the unit may be correlated to access. Future analysis should focus on whether patient access has been inappropriately compromised. Possible factors unexplored in this analysis include differential patient preferences and medical suitability, as well as differential medical access.

(Arch Intern Med 1988;748:2594-2600)

Author Affiliations
From The Urban Institute, Washington, DC (Drs Held and Newmann and Mr Bovbjerg); the Wharton School, University of Pennsylvania, Philadelphia (Dr Pauly); and the Transplant Service, University of California, San Francisco (Dr Salvatierra).

Footnotes
Accepted for publication May 31, 1988.

Reprint requests to The Urban Institute, 2100 M St NW, Washington, DC 20037 (Dr Held).

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