Abstract
Background
Community-level factors contribute to living donor kidney transplantation disparities
but may also influence the interventions aimed to mitigate these disparities. The
Living Donor Navigator Program was designed to separate the advocacy role from the
patient in need of transplantation—friends/family are encouraged to participate as
the patients’ advocates to identify living donors, though some of the patients participate
alone as self-advocates. Self-advocates have a lower living donor kidney transplantation
likelihood compared to the patients with an advocate. We sought to evaluate the relationship
between the patients’ community-level vulnerability and living donor navigator self-advocacy
as a surrogate for program fidelity.
Methods
This single-center, retrospective study included 110 Living Donor Navigator participants
(April 2017–June 2019). Program fidelity was assessed using the participants’ advocacy
status. Measures of community vulnerability were obtained from the Centers for Disease
Control and Prevention Social Vulnerability Index. Modified Poisson regression was
used to evaluate the association between community-level vulnerability and living
donor navigator self-advocacy.
Results
Of the 110 participants, 19% (n = 21) were self-advocates. For every 10% increase
in community-level vulnerability, patients had 17% higher risk of self-advocacy (adjusted
relative risk 1.17, 95% confidence interval: 1.03–1.32, P = .01). Living in areas with greater unemployment (adjusted relative risk: 1.18,
95% confidence interval: 1.04–1.33, P = .01), single-parent households (adjusted relative risk: 1.23, 95% confidence interval:
1.06–1.42, P = .006), minority population (adjusted relative risk: 1.30, 95% confidence interval:
1.04–1.55, P = .02), or no-vehicle households (adjusted relative risk: 1.17, 95% confidence interval:
1.02–1.35, P = .02) were associated with increased risk of self-advocacy.
Conclusion
Having a greater community-level vulnerability was associated with poor Living Donor
Navigator Program fidelity. The potential barriers identified using the Social Vulnerability
Index may direct resource allocation and program refinement to optimize program fidelity
and efficacy for all participants.
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Article info
Publication history
Published online: July 10, 2022
Accepted:
April 20,
2022
Footnotes
Authors Contributions: (I) Research idea and study design: ACK, AJC, RDR, BS, JEL; (II) Data acquisition: ACK, AJC, VK, BJO, RMC, DA, MJH, JEL; (III) Data analysis/interpretation: ACK, AJC, RDR, BS, MCM, VK, HQ, PAM, BJO, RMC, DA, MJH, JEL; (IV) Statistical analysis: ACK, AJC; (V) Drafting of manuscript: ACK, AJC; (VI) Critical revisions of manuscript: ACK, AJC, RDR, BS, MCM, VK, HQ, PAM, BJO, RMC, DA, MJH, JEL; (VII) Supervision and mentorship: RDR, BS, JEL; (VIII) All authors contributed important intellectual content during manuscript drafting and/or revision, approved of the final version of this manuscript, and agree to be accountable for the accuracy and integrity of the study per the International Committee of Medical Journal Editors’ recommendations.
A. Cozette Killian and Alexis J. Carter share co-first authorship.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Invited commentary: Focusing upstream to improve equity in living donor transplantation: From theory to practice in kidney diseaseSurgeryVol. 172Issue 3
- PreviewThe U.S. Department of Health and Human Services in its most recent public health initiative established eliminating health disparities as a priority area with addressing the social determinants of health (SDOH) as an objective to advance health equity.1 Significant disparities based on race and ethnicity exist for patients with end-stage renal disease (ESRD) throughout their disease process.2 In particular, the optimal treatment for ESRD, living donor kidney transplantation, has seen significant disparities increase over the last 2 decades.
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