Rishi Pruthi1,2, Matthew L Robb3, Gabriel C Oniscu4, Charles Tomson5, Andrew Bradley6, John L Forsythe4, Wendy Metcalfe4, Clare Bradley7, Christopher Dudley8, Rachel J Johnson3, Christopher Watson6, Heather Draper9, Damian Fogarty10, Rommel Ravanan8, Paul J Roderick2. 1. Transplant, Renal and Urology Directorate, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom rishi.pruthi@nhs.net. 2. Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. 3. Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, United Kingdom. 4. Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 5. Renal Unit, Freeman Hospital, Newcastle, United Kingdom. 6. Department of Surgery, University of Cambridge and the National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom. 7. Health Psychology Research Unit, Royal Holloway, University of London, Egham, United Kingdom. 8. Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom. 9. Department of Social Science and Systems in Health, University of Warwick, Coventry, United Kingdom. 10. Nephrology Unit, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
Abstract
BACKGROUND AND OBJECTIVES: Despite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study were analyzed to assess preemptive listing (n=2676) and listing within 2 years of starting dialysis (n=1970) by center. RESULTS: Seven hundred and six participants (26%) were listed preemptively, whereas 585 (30%) were listed within 2 years of commencing dialysis. The interquartile range across centers was 6%-33% for preemptive listing and 25%-40% for listing after starting dialysis. Patient factors, including increasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, were associated with a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants were both associated with reduced access to preemptive listing; however Asian participants were associated with a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) were associated with higher preemptive listing, whereas using a written protocol was associated negatively with listing within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). CONCLUSIONS: Patient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, with practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system.
BACKGROUND AND OBJECTIVES: Despite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study were analyzed to assess preemptive listing (n=2676) and listing within 2 years of starting dialysis (n=1970) by center. RESULTS: Seven hundred and six participants (26%) were listed preemptively, whereas 585 (30%) were listed within 2 years of commencing dialysis. The interquartile range across centers was 6%-33% for preemptive listing and 25%-40% for listing after starting dialysis. Patient factors, including increasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, were associated with a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants were both associated with reduced access to preemptive listing; however Asian participants were associated with a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) were associated with higher preemptive listing, whereas using a written protocol was associated negatively with listing within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). CONCLUSIONS:Patient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, with practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system.
Authors: L Ebony Boulware; Lisa A Cooper; Lloyd E Ratner; Thomas A LaVeist; Neil R Powe Journal: Public Health Rep Date: 2003 Jul-Aug Impact factor: 2.792
Authors: Dominic M Taylor; John A Bradley; Clare Bradley; Heather Draper; Rachel Johnson; Wendy Metcalfe; Gabriel Oniscu; Matthew Robb; Charles Tomson; Chris Watson; Rommel Ravanan; Paul Roderick Journal: Kidney Int Date: 2016-09 Impact factor: 10.612
Authors: Jeevan Prakash Gopal; Adam McLean; Jeremy Crane; Paul Herbert; Vassilios Papalois; Frank J M F Dor; Anand Rathnasamy Muthusamy Journal: Transpl Int Date: 2022-06-15 Impact factor: 3.842