If you’re sitting in a dialysis chair in Georgia, you are about half as likely to receive a kidney transplant compared to the average U.S. dialysis patient — and about 25 percent as likely as a patient living in the Northeast.
Kidney transplantation is the optimal treatment for eligible patients with end-stage kidney disease. Yet the Southeast tri-state region of Georgia and North and South Carolina has the lowest kidney transplantation rate in the nation, with Georgia ranking at the very bottom of all states. Dialysis facilities — where patients with end-stage kidney disease receive most of their health care — play a significant role in these unsatisfactory statistics.
In 2007-2010, 86 percent of dialysis facilities in Georgia performed below the national average with respect to kidney transplantation. Across the entire U.S., there were 99 dialysis facilities from which no patients were transplanted over the period studied; 24 of these facilities were located in Georgia, including 10 in the Atlanta area, within just a few miles of two large transplant centers. There are a number of reasons for these disparities; at each level, however, poverty, race and lack of access to health care are central.
African-Americans have less access to kidney transplantation than other patients, and the Southeast has a higher proportion of African-American patients than the rest of the country; 67 percent of dialysis patients in the Southeast are African-American vs. 37 percent in the U.S. overall.
The Southeast has the worst racial disparities in access to kidney transplantation, and the highest concentration of poverty in the nation. In the South, compared to other regions of the country, poverty is intricately linked with poor health outcomes. It is associated with higher rates of stroke, hypertension, diabetes, obesity, low birth weight, infant mortality, hospitalization rates for chronic diseases, and chronic kidney disease.
Solutions to address these disparities must target multiple points along a patient’s pathway to care — at the patient, provider, community and public policy level.
What are some first steps to improve access to transplantation in Georgia? All patients with chronic kidney disease ideally should be informed about treatment options years before they progress to life-threatening end-organ failure. As Federal law requires, patients who have already started dialysis should be educated about transplant as a treatment option. But the content and timing of this education is not yet standardized.
Not surprisingly, patients who live in the Southeast, who are of lower socioeconomic status or African-American, are least likely to receive treatment education. Dialysis facilities and transplant centers should work with partners in the kidney community to develop standards to ensure equity in patient access to this important information. We must next ensure dialysis facilities have enough trained staff to educate patients, since research shows a greater number of staff leads to better transplant access.
What can we do to make an impact on the systemic problem of poverty and access to health care in our community? Expanded access to health insurance is needed. Southern states have among the lowest proportion of insured patients. Health insurance improves access to care, allowing detection and treatment of chronic illnesses such as diabetes and hypertension, the two leading causes of chronic kidney disease.
When treated, progressive organ failure can be slowed or avoided, decreasing the need for dialysis and transplantation. Recent studies show the incidence of end-stage kidney disease is lower, and access to transplantation higher, in states that provide greater access to Medicaid. If our state will not, as it should, expand Medicaid insurance to help cover the more than 1 million Georgians without health insurance, our community should call on policy makers to offer real alternatives.
We have significant economic power in the Southeast; we are the home of CNN, Home Depot, Coca Cola and other formidable businesses. For a part of the country with business and technology strengths, we must find a way to focus some of our resources on these problems, and ensure that racial and socioeconomic health disparities do not worsen in the South, and that Georgia does not remain, again, at the bottom.
Dr. Rachel E. Patzer is a health services researcher at the Emory Transplant Center, and an assistant professor of surgery at the Emory University School of Medicine. Dr. Stephen O. Pastan is the medical director of the kidney and pancreas transplant program at the Emory Transplant Center, and an associate professor of medicine at the Emory University School of Medicine.
