Date of Award

2016

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Public Health Sciences

College

College of Graduate Studies

First Advisor

Kelly J. Hunt

Second Advisor

Leonard Egede

Third Advisor

Mulugeta Gebregziabher

Fourth Advisor

Titte Srinivas

Abstract

Introduction: Although outcome disparities for non-Hispanic Black (NHB) kidney transplant recipients are well known and documented, there is paucity in the data assessing the impact of cardiovascular disease (CVD) risk factors and risk control on racial disparities in kidney transplantation. Methods: Longitudinal study of a national cohort of veteran kidney recipients transplanted between Jan 2001 and Dec 2007 (follow up through Dec 2010) with the aim of determining the prevalence and impact of CVD risk factor and control, compared between NHB and non-Hispanic White (NHW) recipients, on death-censored graft loss (DCGL), overall graft loss and mortality. Data included comprehensive baseline characteristics acquired through the USRDS with detailed follow up clinical, laboratory and medication regimen information acquired through linkage to the VA electronic health records. Analyses were conducted using sequential multivariable modeling (Cox regression), incorporating blocks of variables into iterative nested models. Results: 3,139 patients with complete data were included (2,095 NHW [66.7%] and 1,044 NHBs [33.3%]). At five years post-transplant, NHBs had a higher prevalence of hypertension (100% vs. 99.2%, p<0.01) and post-transplant diabetes (58.9% vs. 53.3%, p<0.01) with reduced control of hypertension (BP <140/90, 60% vs. 69% p<0.01), diabetes (A1c <7%, 35% vs. 47%, p<0.01) and LDL (<100 mg/dL, 55% vs. 61%, p<0.01), when compared to NHWs. Adherence to several medication classes used to manage CVD risk factors was significantly lower in NHBs, as compared to NHWs. The unadjusted risk of DCGL was two-fold higher in NHBs, when compared to NHWs (HR 2.00, 95% CI 1.61-2.49). After adjustment for recipient sociodemographics, donor criteria, transplant characteristics, CVD risk factors and control and post-transplant events, the adjusted independent risk of DCGL was substantially reduced (HR 1.49, 1.11-1.99). CVD risk factors and risk control reduced the influence of NHB race on DCGL by 8.7-17.5%. Similar trends were noted for the outcomes of overall graft loss and mortality and were consistent in multiple sensitivity analyses. Conclusion: These results demonstrate that NHB kidney transplant recipients have substantially higher rates of CVD risk factors and reduced CVD risk control, as compared to NHWs. These issues may be partly related to medication non-adherence and meaningfully contribute to disparities for graft outcomes within NHBs.

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