African-Americans On Medicaid Are Far Less Likely To Receive Living Kidney Transplants

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Transplants / Organ Donations;  Health Insurance / Medical Insurance
Article Date: 24 Jun 2013 - 1:00 PDT Current ratings for:
African-Americans On Medicaid Are Far Less Likely To Receive Living Kidney Transplants

African-Americans with Medicaid as their primary insurance were less likely to receive a living kidney transplant (LKT) than patients with private insurance, according to a new study by researchers at Wake Forest Baptist Medical Center.

The study is published on the Early View online edition of Clinical Transplantation.

"Living kidney transplantation is the optimal treatment for patients with end-stage renal disease, offering the best quality of life and longest survival," said Amber Reeves-Daniel, D.O., assistant professor of nephrology at Wake Forest Baptist and lead author of the study.

African-Americans comprise 12.6 percent of the U.S. population and approximately one-third of the dialysis population. However, they received only 13.5 percent of the living kidney transplants performed in 2011, Reeves-Daniel said.

To try to determine the causes of this discrepancy, the researchers examined differences in LKT based upon ethnicity in 447 privately insured individuals and Medicaid recipients at Wake Forest Baptist from July 2008 through December 2010. As opposed to prior reports from other institutions, primary and secondary payers were included in the analyses, providing a more detailed and accurate picture of insurance coverage for kidney transplant patients.

Most patients had more than one payer, including Medicare, Medicaid, private insurance, Medicare supplements and Medicare replacement policies. Analysis was limited to Caucasians and African-Americans because there were too few Hispanic and Asian recipients to permit meaningful comparisons.

The researchers found that a higher proportion of patients with private insurance, relative to those without private insurance, received LKT - 22 percent versus 7.6 percent. Among ethnic groups, 27.5 percent of Caucasians with private insurance received LKT recipients versus 12.4 percent without private insurance. African- Americans with private insurance were 14 times more likely to receive a live donor kidney than African-Americans without private medical insurance (0.9 percent). African- Americans with Medicaid were unlikely to receive a living kidney transplant, the study found.

"An alarming finding is that despite apparent access to kidney transplantation, no African-American Medicaid recipients received a living donor kidney transplant during the two-and- a-half year study period," Reeves-Daniel said. "It is intuitive that insured patients would be more likely to have donors with sufficient resources to facilitate the processes of living donation. However, it is difficult to explain why individuals with Medicaid, particularly African-Americans, were so much less likely to receive living kidney transplants."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our medicare / medicaid / schip section for the latest news on this subject. Funding for the study was provided by Wake Forest School of Medicine Section on Nephrology.

Co-authors are Alan Farney, M.D., Ph.D., AlisonFletcher, M.D., Jeffrey Rogers, M.D., Robert Stratta, M.D., Michael Rocco, M.D., Barry Freedman, M.D., of Wake Forest Baptist; and Dean Assimos, M.D., of the University of Alabama at Birmingham.

Wake Forest Baptist Medical Center

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posted by Kevin H on 28 Jun 2013 at 12:09 pm

Does this include White Medicaid recipients also? Does race actually have anything to do with this amazing fact?

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'African-Americans On Medicaid Are Far Less Likely To Receive Living Kidney Transplants'

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2015 Fiat 500L Living [w/video]

Turning The World's Largest Fiat Into A Larger Three-Row MPV

We've explored every offering of the Fiat 500 family meant for the United States, plus all of the Abarth variations. But the 500 now also comes super-sized; we recently attended a drive of the larger 2014 Fiat 500L people-mover and its Trekking edition, and found them both to be generally enjoyable. We Americans, however, are suckers for anything that comes in an even bigger size than Large, so witness this Fiat 500L Living, which will be landing on our shores sometime in late 2014.

The essential benefit here is that this 500L is bigger (i.e. longer) by 8.3 inches, thereby adding cargo space and, to our eyes, filling out the natural profile of the slightly scrunched design of the standard 500L. You can maximize your 500L Living cargo space to 59.7 cubic feet by knocking down all the seats, or you can opt for the "+2" seating arrangement that sacrifices 3.5 cubic feet of volume for a tantalizing third row of chairs that seems to turn some consumers into dogs of Pavlov, no matter the degree of usefulness of said added row.
Our tester for this drive day around a quaint region of northern Italy came equipped with everything possible on Fiat's top Lounge trim options list, meaning we did indeed get to try out that third row of seats. Loaded thusly, a 500L Living should be buyable for around $28,000, but we would also opt for the nearly five-foot-long, $950 panoramic glass roof and just remember not to park under any trees to avoid tempting the winged bird-poo squadrons.

Loaded thusly, a 500L Living should be buyable for around $28,000.

This was a European-spec 500L Living, of course, so the baseball-sized shifter knob for the six-speed manual transmission was collaborating with a much lauded 1.6-liter turbo-diesel inline four-cylinder engine huffing out 103 horsepower and a healthy 236 pound-feet of torque. We spent the day hauling around a crew of two and some small camera gear, so we don't yet have a good idea as to how this package will behave with five or more people aboard, and maybe with 100 pounds of stuff. We were curious, though, since the low-revving and quick rev-drop quality of a small diesel motor between gears requires much getting used to when there are heavier loads combined with steep ups and downs in the road.

Naturally, the 500L Living we'll be getting Stateside will have a six-speed twin-clutch transmission as standard equipment, mated to the North American 160-hp, 1.4-liter turbocharged inline four-cylinder gas engine. Apples and oranges weighed equally, it'll cost about the same as this one tested.

The 500L Living is the world's smallest seven-passenger vehicle.

At 175.4 inches long – a little less than a Honda CR-V – the 500L Living is the world's smallest seven-passenger vehicle. This can certainly be seen as something of a plus, but those two pop-up seats are extremely limited in their usefulness. After much soul searching, we had to admit that the best Living will be the one without the third row option. In fact, by eliminating that sometimes irrational attraction, you get greater, more flexible cargo space with the so-called Cargo Magic Space, which is a sizable three-level cargo floor panel that allows you to hide stuff below decks if needed.

For this longer, three-row 500L package, though, we have to ask: would it be better to have sliding doors? Would it be better to have a split rear hatch? For maximum flexibility and usefulness, we'd want both – especially the sliders (think Mazda5). It would make the most sense for tighter European parking situations, too, even though it's not really that big of a deal here in the United States or Canada.

Dynamically, we wouldn't compare the 500L Living's moves to an Infiniti EX or even a Mini Countryman.

One more nice aspect of adding 8.3 inches to the 500L is that overall weight only rises by some 65 pounds over the standard-length 500L. Dynamically, however, we still wouldn't compare the 500L Living's moves to an Infiniti EX or even a Mini Countryman. The Fiat 500L Living with the US-spec 1.4-liter turbocharged motor should get to 60 miles per hour in around 9.8 seconds. This quickness is fine for the intentions of the vehicle; the 500L Living is meant for the practical hauling around of humans, pets, and stuff, while being simple to park, distinctive to stare at and just zippy enough. In Europe, there are 19 exterior colors available, 11 twin-tone possibilities and 15 wheel styles. Our 17-inch optional set of alloys are the largest available rollers on the 500L, and the Continental ContiEcoContact treads – 225/45-seriesall around – were alright on comfort and noise, and surprisingly great in brisker side-to-side dynamics.

The suspension setup is quite the standard fare with no surprises: MacPherson front and compact multi-link rear. But you and we know that expecting phenomenal feedback while thrashing the 500L around is simply not in the cards. This is a rolling style-choice that sets an American driver and family well apart from their neighbors, while also being incredibly practical overall. Visibility looking out as we drove along was, in Fiat people-mover tradition, significantly better than the norm in this part of the market. This makes the 500L Living not only safer in traffic, but also a great road trip choice, too. Maneuverability and steering action are spot-on for a vehicle of this style, which means really tight-turning radii, light-as-a-feather lock-to-lock action for parking structures and good on-center feel in everyday cruising.

There'll be little or nothing like the 500L Living on North American roads.

Inside, you can get full leather if you must, but we would stick with the resilient fabric we had in our tester. We do wish Fiat would create a longer lower seat cushion for generally meatier North American thigh bones, but the seating position and comfort themselves are beyond reproach. That said, we remain confused by the stitched-in quotation that runs across the fabric itself in front and back. Very Euro.

You wanted more Fiats? For now, we're getting more Fiat 500L. Once again, there'll be little or nothing like the 500L Living on North American roads. The 500L and Trekking models and the few new Livings we saw on Italian roads all looked surprisingly better in person than they've come across in photos, we must admit. And Italians, who are pretty good arbiters of what turns heads, turned and looked in approval.

Engine:Turbo-Diesel 1.6L I4Power:103 HP / 236 LB-FTTransmission:6-Speed Manual0-60 Time:12.0 Seconds (est.)Top Speed:112 MPHDrivetrain:Front-Wheel DriveCurb Weight:3,320 LBS (est.)Seating:2+3+2Cargo:56.2 CU-FT (max)MPG:23 City / 32 HWY (est.)Base Price:$25,000 (est.)As-Tested Price:$28,000 (est.)Autoblog accepts vehicle loans from auto manufacturers with a tank of gas and sometimes insurance for the purpose of evaluation and editorial content. Like most of the auto news industry, we also sometimes accept travel, lodging and event access for vehicle drive and news coverage opportunities. Our opinions and criticism remain our own – we do not accept sponsored editorial.

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