BACKGROUND: Socioeconomic and ethnic inequity in access to kidney transplant waiting list has been described in the United States but not examined in a universal healthcare system. METHODS: Eleven thousand two hundred ninety-nine patients aged 18 to 69 years starting renal replacement therapy (January 1, 1997 to December 31, 2004) in England and Wales were included. Multivariable Cox proportional hazards models were used to assess time to activation on the transplant waiting list for socially deprived patients among white patients. The effect of ethnic origin (South Asians and blacks compared with whites) was examined among all patients. RESULTS: Among white patients, in the fully adjusted model, the hazard ratio (HR) for the most deprived quintile was 0.60 (95% confidence interval [CI] 0.54-0.68, P trend <0.0001) compared with the least deprived. Deprivation effects were more pronounced among those 50 years and older (P value for interaction <0.0001). Non-whites had a lower risk of being waitlisted than whites (for blacks: HR 0.89, 95% CI 0.79-1.01; for South Asians: HR 0.91, 95% CI 0.83-0.99, P value for heterogeneity=0.03). These differences were attenuated in a fully adjusted model. However non-whites who were 50 years and older were more likely to be transplant waitlisted than whites (interaction P=0.002). CONCLUSIONS: Individuals living in socially deprived areas have reduced access to the transplant waiting list. Understanding the reasons for this apparent inequity is important if we wish to ensure equitable access to renal transplants. There were no major differences by ethnicity, and if anything, older white patients were less likely to be waitlisted.
BACKGROUND: Socioeconomic and ethnic inequity in access to kidney transplant waiting list has been described in the United States but not examined in a universal healthcare system. METHODS: Eleven thousand two hundred ninety-nine patients aged 18 to 69 years starting renal replacement therapy (January 1, 1997 to December 31, 2004) in England and Wales were included. Multivariable Cox proportional hazards models were used to assess time to activation on the transplant waiting list for socially deprived patients among white patients. The effect of ethnic origin (South Asians and blacks compared with whites) was examined among all patients. RESULTS: Among white patients, in the fully adjusted model, the hazard ratio (HR) for the most deprived quintile was 0.60 (95% confidence interval [CI] 0.54-0.68, P trend <0.0001) compared with the least deprived. Deprivation effects were more pronounced among those 50 years and older (P value for interaction <0.0001). Non-whites had a lower risk of being waitlisted than whites (for blacks: HR 0.89, 95% CI 0.79-1.01; for South Asians: HR 0.91, 95% CI 0.83-0.99, P value for heterogeneity=0.03). These differences were attenuated in a fully adjusted model. However non-whites who were 50 years and older were more likely to be transplant waitlisted than whites (interaction P=0.002). CONCLUSIONS: Individuals living in socially deprived areas have reduced access to the transplant waiting list. Understanding the reasons for this apparent inequity is important if we wish to ensure equitable access to renal transplants. There were no major differences by ethnicity, and if anything, older white patients were less likely to be waitlisted.
Authors: Courtenay M Holscher; Satinderjit S Locham; Christine E Haugen; Sunjae Bae; Dorry L Segev; Mahmoud B Malas Journal: J Nephrol Date: 2019-01-02 Impact factor: 3.902
Authors: Lucy A Plumb; Manish D Sinha; Anna Casula; Carol D Inward; Stephen D Marks; Fergus J Caskey; Yoav Ben-Shlomo Journal: Clin J Am Soc Nephrol Date: 2021-01-19 Impact factor: 8.237
Authors: Sohal Y Ismail; Annemarie E Luchtenburg; Willij C Zuidema; Charlotte Boonstra; Willem Weimar; Emma K Massey; Jan J Busschbach Journal: BMC Nephrol Date: 2012-07-23 Impact factor: 2.388
Authors: Diana A Wu; Matthew L Robb; Christopher J E Watson; John L R Forsythe; Charles R V Tomson; John Cairns; Paul Roderick; Rachel J Johnson; Rommel Ravanan; Damian Fogarty; Clare Bradley; Andrea Gibbons; Wendy Metcalfe; Heather Draper; Andrew J Bradley; Gabriel C Oniscu Journal: Nephrol Dial Transplant Date: 2017-05-01 Impact factor: 5.992