Medical Distrust Among Kidney Transplant Candidates.
Clin Transplant
; 38(7): e15395, 2024 Jul.
Article
en En
| MEDLINE
| ID: mdl-39023087
ABSTRACT
BACKGROUND:
Medical distrust may hinder kidney transplantation (KT) access. Among KT candidates evaluated for waitlisting, we identified factors associated with high distrust levels and quantified their association with waitlisting.METHODS:
Among 812 candidates (2018-2023), we assessed distrust using the Revised Health Care System Distrust Scale across composite, competence, and values subscales. We used linear regression to quantify the associations between candidate and neighborhood-level factors and distrust scores. We used Cox models to quantify the associations between distrust scores and waitlisting.RESULTS:
At KT evaluation, candidates who were aged 35-49 years (difference = 1.97, 95% CI 0.78-3.16), female (difference = 1.10, 95% CI 0.23-1.97), and Black (difference = 1.47, 95% CI 0.47-2.47) were more likely to report higher composite distrust score. For subscales, candidates aged 35-49 were more likely to have higher competence distrust score (difference = 1.14, 95% CI 0.59-1.68) and values distrust score (difference = 0.83, 95% CI 0.05-1.61). Race/ethnicity (Black, difference = 1.42, 95% CI 0.76-2.07; Hispanic, difference = 1.52, 95% CI 0.35-2.69) was only associated with higher values distrust scores. Female candidates reporting higher rescaled values distrust scores (each one point) had a lower chance of waitlisting (aHR = 0.78, 95% CI 0.63-0.98), whereas this association was not observed among males. Similarly, among non-White candidates, each 1-point increase in both rescaled composite (aHR = 0.87, 95% CI 0.77-0.99) and values (aHR = 0.82, 95% CI 0.68-0.99) distrust scores was associated with a lower chance of waitlisting, while there was no association among White candidates.CONCLUSION:
Female, younger, and non-White candidates reported higher distrust scores. Values distrust may contribute to the long-standing racial/ethnic and gender disparities in access to KT. Implementing tailored strategies to reduce distrust in transplant care may improve KT access for groups that experience persistent disparities.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Listas de Espera
/
Trasplante de Riñón
/
Confianza
Límite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Clin Transplant
Asunto de la revista:
TRANSPLANTE
Año:
2024
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
Dinamarca