Association between private insurance and living donor kidney transplant: Affordable Care Act as a natural experiment

Table 1 Characteristics of kidney transplant candidates included in the analytic cohort, n (%)

	22-25 years old				26-29 years old
	All	2005-2009 (pre-ACA)	2010-2014 (post-ACA)	P value	All	2005-2009 (pre-ACA)	2010-2014 (post-ACA)	P value
Age at listing (year) (median, 25%th-75%th)	24 (23, 25)	24 (23, 25)	24 (23, 25)	0.0062	28 (27, 29)	28 (27, 29)	28 (27, 29)	0.1773
Race/ethnicity
White	2543 (38.84)	1250 (38.83)	1293 (38.85)	0.205	2993 (36.96)	1516 (37.08)	1477 (36.843	0.367
Black	1871 (28.58)	949 (29.48)	922 (27.70)		2559 (31.60)	1316 (32.18)	1243 (31.00)
Hispanic	1606 (24.53)	779 (24.20)	827 (24.85)		1785 (22.04)	892 (21.81)	893 (22.27)
Other	527 (8.05)	241 (7.49)	286 (8.59)		762 (9.41)	365 (8.93)	397 (9.90)
Gender
Male	3692 (56.39)	1803 (56.01)	1889 (56.76)	0.558	4376 (54.03)	2182 (53.36)	2194 (54.71)	0.219
Female	2855 (43.61)	1415 (43.99)	1439 (43.24)		3723 (45.97)	1907 (46.64)	1816 (45.29)
Body mass index (kg/m2)	24.33 (21.27, 29.15)	24.41 (21.33, 29.03)	24.23 (21.16, 29.23)	0.431	25.59 (22.15, 30.29)	25.46 (22.13, 30.00)	25.72 (22.19, 30.78)	0.0088
Diabetes status
No diabetes	6120 (93.48)	2994 (93.01)	3126 (93.93)		6789 (83.39)	3410 (83.39)	3379 (84.26)
Diabetes	427 (6.52)	225 (6.99)	202 (6.07)	0.132	1310 (16.17)	679 (16.61)	631 (15.74)	0.288
Educational attainment
Less than high school	249 (3.80)	136 (4.22)	113 (3.40)	< 0.001	330 (4.07)	171 (4.18)	159 (3.97)	< 0.001
High school graduate or general equivalency diploma	3136 (47.89)	1572 (48.84)	1564 (47.00)		3549 (43.71)	1784 (43.63)	1756 (43.79)
Some college	2060 (31.46)	901 (27.99)	1159 (34.83)		2234 (27.58)	1049 (25.65)	1185 (29.55)
College graduate or higher	771 (11.78)	342 (10.62)	429 (12.89)		1498 (18.50)	689 (16.85)	809 (20.17)
Missing or unknown	331 (5.06)	269 (8.33)	63 (1.89)		497 (6.14)	396 (9.68)	101 (2.52)
Employment status
Not employed	4200 (64.15)	1998 (62.07)	2202 (66.17)	< 0.001	4776 (58.97)	2345 (57.35)	2431 (60.62)	< 0.001
Employed	2004 (30.61)	980 (30.44)	1024 (30.77)		2891 (35.70)	1419 (34.70)	1472 (36.71)
Missing or unknown	343 (5.24)	241 (7.49)	102 (3.06)		432 (5.33)	325 (7.95)	107 (2.67)
Primary cause of renal failure
Cystic kidney disease	137 (2.09)	55 (1.71)	82 (2.46)	0.019	197 (2.43)	82 (2.01)	115 (2.87)	0.001
Diabetes mellitus	298 (4.55)	164 (5.09)	134 (4.03)		1110 (13.71)	565 (13.82)	545 (13.59)
Hypertension	1017 (15.53)	525 (16.31)	492 (14.78)		1461 (18.04)	775 (18.95)	686 (17.11)
Glomerulonephritis	2837 (43.33)	1375 (42.72)	1462 (43.93)		3231 (39.89)	1567 (38.32)	1664 (41.50)
Other/unknown	2258 (34.49)	1100 (34.17)	1158 (34.80)		2100 (25.93)	1100 (26.90)	1000 (24.94)
Pre-emptively waitlisted
No	5155 (28.74)	2588 (80.40)	2567 (77.13)	0.001	6170 (76.18)	3190 (78.01)	2980 (74.31)	< 0.001
Yes	1392 (21.26)	631 (19.60)	761 (22.87)		1929 (23.82)	899 (21.99)	1030 (25.69)
Primary payer at waitlist registration
Private	2537 (38.75)	1140 (35.41)	1397 (41.98)	< 0.001	3156 (38.97)	1602 (39.18)	1554 (38.75)	0.090
Medicare	2634 (40.23)	1371 (42.59)	1263 (37.95)		3397 (41.94)	1736 (42.46)	1661 (41.42)
Medicaid	1184 (18.08)	599 (18.61)	585 (17.58)		1322 (16.32)	629 (15.38)	693 (17.28)
All others	192 (2.93)	109 (3.39)	83 (2.49)		224 (2.77)	122 (2.98)	102 (2.54)
Waitlist outcomes
Deceased donor transplant	2416 (36.90)	1191 (37.00)	1225 (36.81)	< 0.001	2988 (36.89)	1563 (38.22)	1425 (35.54)	< 0.001
Living donor transplant	1858 (28.38)	933 (28.98)	925 (27.79)		2036 (25.14)	1014 (24.80)	1022 (25.49)
Died on waitlist	427 (6.52)	251 (7.80)	176 (5.29)		591 (7.30)	357 (8.73)	234 (5.84)
Removed from waitlist for reason other than transplant or death	1648 (25.17)	804 (24.98)	844 (25.36)		2258 (27.88)	1114 (27.24)	1144 (28.53)
Still on waitlist	198 (3.02)	40 (1.24)	158 (4.75)		226 (2.79)	41 (1.00)	185 (4.61)

ACA: Affordable Care Act.