Demographic, psychosocial, and medical determinants of medical utilization in renal transplant recipients

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)



First Committee Member

Andrew L. Brickman - Committee Chair

Second Committee Member

Gail H. Ironson - Committee Member


Kidney transplantation remains the preferred treatment of end-stage renal disease (ESRD) for many. However, noncompliance with the post-transplantation regimen is a leading cause of graft failure. Noncompliance has been related to increased medical utilization. Psychosocial factors related to noncompliance and medical utilization have been examined in other medical populations but not in ESRD patients. The purpose of this study was to investigate the role of psychosocial factors in medical utilization during the first year following transplantation. Selection of predictor variable was accomplished with multiple regression analyses within medical, demographic, affective, and dispositional domains. Outcome variables included one-year total, inpatient, and outpatient costs and average length of stay. Variables surviving domain regression analyses were entered into final regression models, with medical variables serving as control variables.The results indicated that variables representing aspects of the family environment emerged as the most important predictors of medical utilization. The degree to which family environments are characterized by independence/assertiveness and organization accounted for a significant proportion of the variance in both increased total costs and inpatient costs over and above that accounted for by medical variables. Psychological variables failed to significantly predict outpatient costs and average length of stay. Fewer years of education and non-American ethnicity were significantly associated with increased outpatient costs, whereas only race (non-White) emerged as a significant predictor of longer average length of stay after controlling for medical variables.The findings of this study suggest that aspects of the family environment are significant predictors of medical utilization in renal transplant recipients independent of the predictive influence of medical variables. Future research including more comprehensive data on both social support/family environment and utilization may enhance the ability to identify kidney transplant recipients at risk for increased medical utilization and poor physical health outcomes.


Health Sciences, Mental Health; Psychology, Social; Health Sciences, Medicine and Surgery; Psychology, Clinical

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