The Roles of Race/Ethnicity & Substance Use in Predicting Likelihood of Kidney Transplantation

For individuals in need of a kidney transplant, disparities related to race and ethnicity have persisted for decades, with Black and Hispanic patients at a disadvantage relative to non-Hispanic White patients, regarding receipt of organ transplantation.

Mary Amanda Dew, PhD, Professor of Psychiatry, Psychology, Epidemiology, Biostatistics, Clinical and Translational Science, and Acute and Tertiary Care (Nursing), is an expert in the intersection of psychiatry and transplantation. Dr. Dew, Richelle DeBlasio (medical student, Pitt School of Medicine), and colleagues hypothesized that race and ethnicity disparities in kidney transplantation may be further heightened when coupled with substance use (including tobacco use, heavy alcohol consumption, or illicit use of other substances). The same psychosocial factors that can help explain race/ethnicity barriers to receipt of kidney transplantation—including fewer financial resources to support health and clinician bias—can also serve as barriers to treatment for substance use and for space on a list to receive a transplant. In addition, the “double jeopardy hypothesis” in social and psychological research on health proposes that people who belong to multiple potentially stigmatized groups (here, racial/ethnic minorities and individuals who use substances) face the greatest disparities in health and receipt of health care. 

The investigators studied a cohort of 1,152 individuals identifying as non-Hispanic White, Black, or other minority races/ethnicities, undergoing evaluation for kidney transplantation. They examined whether likelihood of transplantation could be predicted by the unique combination of patients’ race/ethnicity and whether they used any substances at the time of their evaluation for transplant. The findings revealed marked disparities in overall incidence of transplantation: the two minority groups of substance users were 55% to 67% less likely to ever receive transplants than the referent group of White nonusers. In contrast, White users did not differ from White nonusers in likelihood of eventual transplant, and minority group patients who did not use substances also did not differ from White nonusers. The team published their findings in Transplantation.

“The emphasis in most healthcare disparities research is on uncovering individual factors that contribute to inequities,” said Dr. Dew, the study’s senior author. “But certain combinations of those factors may be particularly deleterious; they can place some patients in ‘double jeopardy,’ and further magnify the disparities. This is patently unfair. We have a severe shortage of organs for transplantation, and it is critical that all individuals receive equitable consideration—and equitable opportunities to address factors such as substance use—so they have a chance to receive this lifesaving intervention. Clinicians must be aware of the potential for the double jeopardy phenomenon and work against it by, for example, helping to remove barriers to referral and receipt of substance use treatment among all patients. We must also continue to enhance clinicians’ cultural competence, especially regarding any implicit biases they may hold about substance use in racial/ethnic minority groups.” 

The combined roles of race/ethnicity and substance use in predicting likelihood of kidney transplantation
DeBlasio R, Myaskovsky L, DiMartini AF, Croswell E, Posluszny DM, Puttarajappa C, Switzer GE, Shapiro R, DeVito Dabbs AJ, Tevar AD, Hariharan S, Dew MA.

Transplantation: April 2022; Volume 106, Issue 4; pages e219-e233. doi: 10.1097/TP.0000000000004054