Renal transplantation outcome and social deprivation in the French healthcare system: a cohort study using the European Deprivation Index.

The study objective was to estimate the effect of social deprivation estimated by the European Deprivation Index (EDI) on the risk of death and graft failure on renal transplantation in France. EDI was calculated for 8701 of 9205 patients receiving a first renal transplantation between 2010 and 2014. Patients were separated in EDI quintiles of the general population. A Cox model (cs-HR: cause-specific hazard ratio of death or graft failure) and a Fine and Gray model (sd-HR: subdistribution hazard ratio of death and graft failure) were used for the analysis. The 5th quintile group (most deprived) accounted for 32% of patients [2818 of 8701]. In the multivariate analysis, compared with quintile 1, the risk of death was higher for the 5th quintile group in the complete cohort [cs-HR: 1.31, 95% CI: (1.01-1.70), sd-HR: 1.29, 95% CI: (1.00-1.68)], in the deceased donor group [cs-HR: 1.31, 95% CI: (1.00-1.71), sd-HR: 1.30, 95% CI: (1.00-1.70)] but not in living donor transplant patients. There was no association between the EDI groups and the risk of transplant failure. Social deprivation estimated by the EDI is associated with an increased risk of death in transplantation in France but not with the chance of allograft loss.