Framing Disparities Along the Continuum of Care from Chronic Kidney Disease to Transplantation: Barriers and Interventions

Authors

  • K. Ladin,

    Corresponding author
    1. Transplant Institute and Center for Transplant Outcomes and Quality Improvement at Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA
    2. Department of Health Policy, Harvard University, Cambridge, MA
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  • J. R. Rodrigue,

    1. Transplant Institute and Center for Transplant Outcomes and Quality Improvement at Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA
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  • D. W. Hanto

    1. Transplant Institute and Center for Transplant Outcomes and Quality Improvement at Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA
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* Corresponding author: Keren Ladin, kladin@post.harvard.edu

Abstract

Research in renal transplantation continues to document scores of disparities affecting vulnerable populations at various stages along the transplantation process. Given that both biological and environmental determinants contribute significantly to variation, identifying factors underlying an unfairly biased distribution of the disease burden is crucial. Confounded definitions and gaps in understanding causal pathways impede effectiveness of interventions aimed at alleviating disparities. This article offers an operational definition of disparities in the context of a framework aimed at facilitating interventional research. Utilizing an original framework describing the entire continuum of the transplant process from diagnosis of chronic kidney disease through successful transplant, this article explores the case of racial disparities, illustrating key factors predicting and perpetuating disparities. Though gaps in current research leave us unable to identify which stages of the transplant pathway adversely affect most people, by identifying key risk factors across the continuum of care, this article highlights areas suited for targeted interventions and presents recommendations for improvement and future research.

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