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 Those with linguistic barriers - especially in Hispanic and Asian
households - also wait longer for a transplant evaluation or never
complete one at all.
“The problem likely extends further than merely language. Cultural
and educational barriers likely also play a role,” said senior study
author Edmund Huang of the Kidney Transplant Program at Cedars-Sinai
Medical Center in Los Angeles, California.
“Transplant centers and referring nephrologists should recognize
that these populations may need additional attention in guiding them
through the evaluation process,” he told Reuters Health.
The Organ Procurement and Transplantation Network currently has more
than 98,000 candidates on the kidney transplant waiting list.
Typically, a third of these patients are listed as inactive due to
an incomplete transplant evaluation, and about a third of inactive
candidates never become active. Figuring out why candidates remain
inactive and how to move them to active status could reduce health
disparities in underserved communities, the study authors write in
the Clinical Journal of the American Society of Nephrology.
Huang and colleagues looked at nationwide organ transplant data,
along with ZIP code data from the 2000 United States census, for
more than 84,000 kidney transplant candidates from 2004-2012.
They defined a household as “linguistically isolated” if all members
over age 14 spoke a language other than English and spoke English
less than “very well.” The researchers then categorized
neighborhoods where transplant candidates lived into one of five
groups based on the percentage of households that were
linguistically isolated: less than 1 percent, between 1 and 5
percent, between 5 and 10 percent, between 10 and 20 percent or more
than 20 percent.
During the study, more than 70 percent of candidates moved to active
status. These candidates were more often younger, male, more
educated and more likely to have private health insurance. Inactive
candidates generally lived in communities with lower education and
more poverty. Although Hispanic, Asian and black candidates were all
less likely to achieve active status, Hispanic and Asian candidates
were more likely to live in areas with the highest levels of
linguistic isolation.
Overall, 78 percent of candidates who lived in communities with less
than 1 percent of linguistic isolation converted to active status.
In communities that were more than 20 percent linguistically
isolated, 69 percent converted to active status, researchers found.
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“Despite our best efforts to make kidney transplantation accessible
to all suitable patients with end-stage renal disease, there are
barriers,” Huang said.
Although the nationwide kidney allocation policy changed in 2014 to
reduce racial and ethnic disparities in kidney transplantation, the
problem starts sooner than allocation, Huang added.
“When people need a transplant, they want to be sure that kidneys
are allocated because of medical necessity and that they are not
disadvantaged because of their social status,” said Alicia Fernandez
of the University of California at San Francisco, who was not
involved in the study.
“Kidney transplant is a scarce resource, and it is important that
scarce medical resources be distributed fairly,” said Fernandez, who
has studied language barriers in healthcare, particularly for
Latinos with diabetes. “That has generally been understood to mean
without unduly valuing social factors, such as wealth or race,” she
said by email.
One limitation of the study is that although language barriers are
likely tied to education and income barriers, the study authors
can’t say for sure. Other systemic biases could prevent patients
from completing evaluations or joining the waitlist, said Leah
Karliner of the University of California at San Francisco, who
wasn’t involved with the study but has studied language barriers to
healthcare access and how professional interpreters may help.
“It is unclear how many of these patients had access to professional
interpretation in their health care settings and for navigating the
complex health care system to complete their evaluation,” she told
Reuters Health by email. “An important starting place would be
ensuring access to professional interpretation for all patients.”
SOURCE: http://bit.ly/2lj3DDZ Clinical Journal of the American
Society of Nephrology, online February 9, 2017.
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