Sehoon Park1,2, Jina Park3, Myoungsuk Kim3, Ji Eun Kim4, Mi-Yeon Yu5, Kwangsoo Kim6, Minsu Park7, Yong Chul Kim8, Dong Ki Kim8,9,10, Kwon Wook Joo8,9,10, Yon Su Kim1,8,9,10, Hajeong Lee11,12. 1. Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea. 2. Department of Internal Medicine, Armed Forces Capital Hospital, Seoul, Republic of Korea. 3. Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea. 4. Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea. 5. Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Republic of Korea. 6. Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea. 7. Department of Statistics, Keimyung University, Daegu, Republic of Korea. 8. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. 9. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. 10. Kidney Research Institute, Seoul National University, Seoul, Republic of Korea. 11. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. mdhjlee@gmail.com. 12. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. mdhjlee@gmail.com.
Abstract
BACKGROUND: Socioeconomic status is an important determinant for patients' accessibility to, and prognosis of, kidney transplantation. However, the association between socioeconomic dependency and kidney transplantation accessibility or prognosis after kidney transplantation remains unclear. METHODS: In this nationwide cohort study, based on the claims database of South Korea, we included 12,889 kidney transplant recipients from 2007 to 2015 and stratified them according to health insurance categories that reflect socioeconomic dependency: workplace-independent (employed, N = 3257), workplace-dependent (dependent to the workplace-independent, N = 3661), community-representative (heads of the household but self-employed or unemployed, N = 2479), community-member (N = 1618), aided-representative (heads of household receiving medical aid from the government, N = 1580), and aided-member (N = 294). The incidence of kidney transplantation was calculated to evaluate its accessibility. The risk of graft failure was assessed using the Cox regression analysis, adjusted for clinicodemographic variables, including financial status. RESULTS: End-stage kidney disease patients who were employed (workplace-independent group) had the highest incidence proportion of kidney transplantation. The dependent groups' prognoses were worse than those of their independent counterparts [workplace-dependent versus workplace-independent, HR 1.26 (1.11-1.43) and community-dependent versus community-independent, HR 1.46 (1.23-1.74)], although no difference was observed between the aided subgroups [aided-dependent versus aided-independent, adjusted HR 1.16 (0.90-1.50)]. CONCLUSION: Disparities in kidney transplantation accessibility were present in South Korea according to socioeconomic dependency; these differences may have an impact on prognosis.
BACKGROUND: Socioeconomic status is an important determinant for patients' accessibility to, and prognosis of, kidney transplantation. However, the association between socioeconomic dependency and kidney transplantation accessibility or prognosis after kidney transplantation remains unclear. METHODS: In this nationwide cohort study, based on the claims database of South Korea, we included 12,889 kidney transplant recipients from 2007 to 2015 and stratified them according to health insurance categories that reflect socioeconomic dependency: workplace-independent (employed, N = 3257), workplace-dependent (dependent to the workplace-independent, N = 3661), community-representative (heads of the household but self-employed or unemployed, N = 2479), community-member (N = 1618), aided-representative (heads of household receiving medical aid from the government, N = 1580), and aided-member (N = 294). The incidence of kidney transplantation was calculated to evaluate its accessibility. The risk of graft failure was assessed using the Cox regression analysis, adjusted for clinicodemographic variables, including financial status. RESULTS: End-stage kidney diseasepatients who were employed (workplace-independent group) had the highest incidence proportion of kidney transplantation. The dependent groups' prognoses were worse than those of their independent counterparts [workplace-dependent versus workplace-independent, HR 1.26 (1.11-1.43) and community-dependent versus community-independent, HR 1.46 (1.23-1.74)], although no difference was observed between the aided subgroups [aided-dependent versus aided-independent, adjusted HR 1.16 (0.90-1.50)]. CONCLUSION: Disparities in kidney transplantation accessibility were present in South Korea according to socioeconomic dependency; these differences may have an impact on prognosis.
Entities:
Keywords:
Disparity; Graft failure; Kidney transplantation; Socioeconomic status
Authors: Matthew R D'Costa; Andrew Bentall; Aleksandar Denic; Carrie A Schinstock; Massini A Merzkani; Walter D Park; Margaret S Ryan; Mariam P Alexander; Byron H Smith; Manish J Gandhi; Mark D Stegall Journal: Transplantation Date: 2021-11-01 Impact factor: 4.939