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Ann C. Klassen, PhD, Allyson G. Hall, PhD, Brit Saksvig, PhD, MHS, Barbara Curbow, PhD and David K. Klassen, MD

Ann C. Klassen and Barbara Curbow are with the Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Md. At the time of the study, Allyson G. Hall was with the Department of Health Policy and Management, and Brit Saksvig was with the Department of International Health, Johns Hopkins School of Public Health. David K. Klassen is with the Department of Medicine, University of Maryland School of Medicine, Baltimore.

Correspondence: Requests for reprints should be sent to Ann C. Klassen, PhD, Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, 624 N Broadway, Room 745, Baltimore, MD 21205 (e-mail: aklassen{at}jhsph.edu).

Objectives. This study explored wait-listing decisions among African American and White men and women eligible for kidney transplants, focusing on lifetime experiences of race and sex discrimination as a possible influence.

Methods. Patient records from 3 Baltimore-area hemodialysis units were reviewed, and semistructured face-to-face interviews were conducted with transplant-eligible patients and with unit staff members.

Results. African American patients reported more racial discrimination, and women reported more sex discrimination. Women and older patients were less likely to be placed on the waiting list, as were patients with previous experiences of racial discrimination. Discrimination measures predicted list access more strongly than patient race.

Conclusions. Lifetime experience of and response to discrimination may contribute to race and sex differences in access to care and should be included in research on health care disparities.

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