Date of Award

Fall 8-1-2025

Embargo Period

10-31-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Nursing Science

Department

Nursing

College

College of Nursing

First Advisor

Susan Newman

Second Advisor

Martina Mueller

Third Advisor

Jennifer Gander

Fourth Advisor

Gayenell Magwood

Abstract

Purpose – The purpose of this dissertation is to investigate the relationship between demographics and Social Determinants of Health (SDOH) variables on diagnostic testing time completion in patients being evaluated for kidney transplant waitlisting.

Aims - Compared to White Americans, African Americans who are eligible to receive a kidney transplant are less likely to complete the required testing in order to be placed on the kidney transplant waiting list which puts African Americans at risk for morbidity and mortality due to prolonged exposure to dialysis. The COVID-19 pandemic was directly associated with a decrease in the number of patients placed on the kidney transplant waiting list, however, it is not clear if the pandemic specifically had an impact on evaluation completion time in preparation for kidney transplant waitlisting. The aims of this dissertation are to first determine the average time to evaluation completion in patients evaluated for kidney transplant waitlisting. Secondly, to investigate whether there is a relationship between demographics and SDOH variables on kidney transplant evaluation completion. Lastly, to investigate the effects of the COVID-19 pandemic on diagnostic evaluation completion during the following periods: January 2018 – February 2020 (pre-pandemic), March 2020 – March 2022 (lockdown and pandemic), April 2022 – March 2024 (“post”-pandemic).

Design and Theoretical Basis – Guided by the Social Ecological Model (SEM), we conducted a retrospective cohort study analyzing existing data from a large academic medical center in the southeastern United States (U.S.) to determine the average time to diagnostic test completion in patients who were evaluated for kidney transplantation and investigated whether there is a relationship between demographics and SDOH variables with diagnostic testing time completion.

Findings – African Americans took longer to complete the evaluation for kidney transplant waitlisting compared to White Americans. We used the Social Deprivation Index (SDI) as a proxy measure for SDOH variables and noted that evaluation completion was not dependent on race and SDI combined which raises the question of whether SDI was the best proxy measure for SDOH. When the COVID-19 time periods were investigated, the evaluation completion time across each COVID-19 time period (pre, pandemic, and post pandemic) was consistently longer for African Americans compared to White Americans. The disparity in time to evaluation completion between African American and White patients widened in the “post” COVID-19 period with African American patients experiencing significantly longer delays.

Conclusion – Recommendations are provided which may have an impact on time to evaluation completion in preparation for placement on the kidney transplant waiting list.

Rights

Copyright is held by the author. All rights reserved.

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