The Role of the Social Milieu On Health Outcomes: Is It Who You Know or What Who You Know Knows?

PURPOSE:  Research has shown that black dialysis patients are significantly less likely than their white peers to be evaluated and listed for a kidney transplant. Despite a Healthy People target of 30% of End Stage Renal Disease patients receiving a kidney transplant, in 2009 only 18% of black patients achieved this goal, compared to 37% of white patients who received a kidney transplant (U.S. Renal Data System, 2011). Extrapolating from social network theory, I hypothesize that a lack of access to social contacts with information about kidney transplantation may hinder information transaction regarding the benefits of, and pathway to, transplantation. Explanations for underutilization of transplantation as a treatment modality for black ESRD patients have focused primarily on socioeconomic, medical, patient-preference, and information factors, with limited attention to the social milieu of dialysis patients. The contribution of the present study is to investigate previously unconsidered social determinants that might influence disparate health outcomes.

METHODS: In 2007-2008, the following research questions were addressed in an investigation in Chicago, IL: (1) What is the role of social networks in providing information about kidney transplantation to black hemodialysis patients? (2) What is the relationship between social networks and a patient’s likelihood of being seen at a kidney transplant center? From a stratified sample of dialysis units in the area, a purposive sample of 228 black patients were surveyed while they received treatment about their social networks and kidney transplant status.

RESULTS:  The odds of black hemodialysis patients being seen at a kidney transplant center increase with income (OR 1.38, 95%CI: 1.09-1.76, p<.01), and patients who have people in their social network with information about kidney transplant were significantly more likely to be seen at a kidney transplant center. Specifically, black dialysis patients who get informational social support from their dialysis team (OR 1.76, 95%CI: 1.5-2.1, p<.001) and social networks (OR 1.63, 95%CI: 1.2-2.3, p<.001) were significantly more likely to be seen at kidney transplant centers.

IMPLICATIONS:  Health parity is a multifaceted social problem, and considering black dialysis patients’ social milieu can be complimentary to the important existing research regarding kidney transplantation outcomes. The logistic regression models imply that correct information about a kidney transplant and success of being seen at a kidney transplant center can be differentiated on the basis of considering social network informational attributes and income. Dialysis health teams, which include a Master’s level social worker on every team, can augment patients’ social networks through their own interventions or by linking patients with mentors or patient navigators.

U.S. Renal Data System. (2011). Annual Data Report. Bethesda, MD: National Institutes of Health & National Institute of Diabetes and Digestive and Kidney Diseases.