Inequity in Access to Transplantation in the United Kingdom.
Adolescent
Adult
Age Factors
Aged
Asian People
/ statistics & numerical data
Black People
/ statistics & numerical data
Body Mass Index
Comorbidity
Female
Health Services Accessibility
/ statistics & numerical data
Healthcare Disparities
/ ethnology
Humans
Kidney Failure, Chronic
/ therapy
Kidney Transplantation
/ statistics & numerical data
Male
Middle Aged
Practice Patterns, Physicians'
Prospective Studies
Renal Dialysis
Social Class
United Kingdom
Waiting Lists
Young Adult
African Americans
Body Mass Index
Cohort Studies
Diagnosis-Related Groups
Epidemiology and outcomes
Ethnic Groups
Health Care
Minority Groups
Outcome Assessment
Prospective Studies
Renal Replacement Therapy
Social Class
Universal Health Care
clinical epidemiology
ethnicity
inequity
kidney transplantation
renal dialysis
socio-economic deprivation
transplant waiting list
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
08 06 2020
08 06 2020
Historique:
received:
23
09
2019
accepted:
24
04
2020
pubmed:
30
5
2020
medline:
21
10
2021
entrez:
30
5
2020
Statut:
ppublish
Résumé
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. 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 ( 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/m 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.
Sections du résumé
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 (
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/m
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.
Identifiants
pubmed: 32467306
pii: 01277230-202006000-00014
doi: 10.2215/CJN.11460919
pmc: PMC7274279
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
830-842Subventions
Organisme : Department of Health
ID : RP-PG-0109-10116
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 by the American Society of Nephrology.
Références
Public Health England: Chronic kidney disease prevalence model, 2014. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/612303/ChronickidneydiseaseCKDprevalencemodelbriefing.pdf . Accessed September 15, 2019
MacNeill SJ, Ford D, Evans K, Medcalf JF: Chapter 2 UK renal replacement therapy adult prevalence in 2016: National and centre-specific analyses. Nephron 139[Suppl 1]: 47–74, 2018 29990998
Gilg J, Methven S, Casula A, Castledine C: UK renal registry 19th annual report: Chapter 1 UK RRT adult incidence in 2015: National and centre-specific analyses. Nephron 137[Suppl 1]: 11–44, 2017 28930721
United States Renal Data System: 2017 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2017
Volkova N, McClellan W, Klein M, Flanders D, Kleinbaum D, Soucie JM, Presley R: Neighborhood poverty and racial differences in ESRD incidence. J Am Soc Nephrol 19: 356–364, 2008 18057219
Ward MM: Socioeconomic status and the incidence of ESRD. Am J Kidney Dis 51: 563–572, 2008 18371532
Roderick PJ, Raleigh VS, Hallam L, Mallick NP: The need and demand for renal replacement therapy in ethnic minorities in England. J Epidemiol Community Health 50: 334–339, 1996 8935467
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK: Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341: 1725–1730, 1999 10580071
Oniscu GC, Brown H, Forsythe JL: Impact of cadaveric renal transplantation on survival in patients listed for transplantation. J Am Soc Nephrol 16: 1859–1865, 2005 15857921
Neipp M, Karavul B, Jackobs S, Meyer zu Vilsendorf A, Richter N, Becker T, Schwarz A, Klempnauer J: Quality of life in adult transplant recipients more than 15 years after kidney transplantation. Transplantation 81: 1640–1644, 2006 16794528
Schneider EC, Sarnak DO, Squires D, Shah A, Doty MM: Mirror, mirror 2017: International comparison reflects flaws and opportunities for better U.S. health care, 2017. Available at: https://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-2017-international-comparison-reflects-flaws-and . Accessed September 15, 2019
Meier-Kriesche HU, Kaplan B: Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A paired donor kidney analysis. Transplantation 74: 1377–1381, 2002 12451234
Taylor D, Robb M, Casula A, Caskey F: UK renal registry 19th annual report: Chapter 11 centre variation in access to kidney transplantation (2010-2015). Nephron 137[Suppl 1]: 259–268, 2017 28930730
Oniscu GC, Schalkwijk AA, Johnson RJ, Brown H, Forsythe JL: Equity of access to renal transplant waiting list and renal transplantation in Scotland: Cohort study. BMJ 327: 1261, 2003
Ravanan R, Udayaraj U, Ansell D, Collett D, Johnson R, O’Neill J, Tomson CR, Dudley CR: Variation between centres in access to renal transplantation in UK: Longitudinal cohort study. BMJ 341: c3451, 2010 20647283
Kasiske BL, London W, Ellison MD: Race and socioeconomic factors influencing early placement on the kidney transplant waiting list. J Am Soc Nephrol 9: 2142–2147, 1998 9808103
Yeates KE, Schaubel DE, Cass A, Sequist TD, Ayanian JZ: Access to renal transplantation for minority patients with ESRD in Canada. Am J Kidney Dis 44: 1083–1089, 2004 15558530
Oniscu GC, Ravanan R, Wu D, Gibbons A, Li B, Tomson C, Forsythe JL, Bradley C, Cairns J, Dudley C, Watson CJ, Bolton EM, Draper H, Robb M, Bradbury L, Pruthi R, Metcalfe W, Fogarty D, Roderick P, Bradley JA; ATTOM Investigators: Access to transplantation and transplant outcome measures (ATTOM): Study protocol of a UK wide, in-depth, prospective cohort analysis. BMJ Open 6: e010377, 2016 26916695
Pruthi R, Tonkin-Crine S, Calestani M, Leydon G, Eyles C, Oniscu GC, Tomson C, Bradley A, Forsythe JL, Bradley C, Cairns J, Dudley C, Watson C, Draper H, Johnson R, Metcalfe W, Fogarty D, Ravanan R, Roderick PJ; ATTOM Investigators: Variation in practice patterns for listing patients for renal transplantation in the United Kingdom: A national survey. Transplantation 102: 961–968, 2018 29215463
Alexander GC, Sehgal AR: Barriers to cadaveric renal transplantation among blacks, women, and the poor. JAMA 280: 1148–1152, 1998 9777814
Grams ME, Chen BP, Coresh J, Segev DL: Preemptive deceased donor kidney transplantation: Considerations of equity and utility. Clin J Am Soc Nephrol 8: 575–582, 2013 23371953
Riffaut N, Lobbedez T, Hazzan M, Bertrand D, Westeel PF, Launoy G, Danneville I, Bouvier N, Hurault de Ligny B: Access to preemptive registration on the waiting list for renal transplantation: A hierarchical modeling approach. Transpl Int 28: 1066–1073, 2015 25877385
Navaneethan SD, Singh S: A systematic review of barriers in access to renal transplantation among African Americans in the United States. Clin Transplant 20: 769–775, 2006 17100728
Taylor DM, Bradley JA, Bradley C, Draper H, Johnson R, Metcalfe W, Oniscu G, Robb M, Tomson C, Watson C, Ravanan R, Roderick P; ATTOM Investigators: Limited health literacy in advanced kidney disease. Kidney Int 90: 685–695, 2016 27521115
Grubbs V, Gregorich SE, Perez-Stable EJ, Hsu CY: Health literacy and access to kidney transplantation. Clin J Am Soc Nephrol 4: 195–200, 2009 19056617
Jeffrey RF, Woodrow G, Mahler J, Johnson R, Newstead CG: Indo-Asian experience of renal transplantation in Yorkshire: Results of a 10-year survey. Transplantation 73: 1652–1657, 2002 12042655
Udayaraj U, Ben-Shlomo Y, Roderick P, Casula A, Dudley C, Collett D, Ansell D, Tomson C, Caskey F: Social deprivation, ethnicity, and uptake of living kidney donor transplantation in the United Kingdom. Transplantation 93: 610–616, 2012 22245879
Norris KC, Agodoa LY: Unraveling the racial disparities associated with kidney disease. Kidney Int 68: 914–924, 2005 16105022
Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR: Race and trust in the health care system. Public Health Rep 118: 358–365, 2003 12815085
Bratton C, Chavin K, Baliga P: Racial disparities in organ donation and why. Curr Opin Organ Transplant 16: 243–249, 2011 21415828
Doshi M, Garg AX, Gibney E, Parikh C: Race and renal function early after live kidney donation: An analysis of the United States organ procurement and transplantation network database. Clin Transplant 24: E153–E157, 2010 20184631