Are There Inequities in Treatment of End-Stage Renal Disease in Sweden? A Longitudinal Register-Based Study on Socioeconomic Status-Related Access to Kidney Transplantation.

Ye Zhang,Johan Jarl,Ulf-G Gerdtham

doi:10.3390/ijerph14020119

Ye Zhang, Johan Jarl + Show 1 more

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https://doi.org/10.3390/ijerph14020119

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Abstract

Socioeconomic status-related factors have been associated with access to kidney transplantation, yet few studies have investigated both individual income and education as determinates of access to kidney transplantation. Therefore, this study aims to explore the effects of both individual income and education on access to kidney transplantation, controlling for both medical and non-medical factors. We linked the Swedish Renal Register to national registers for a sample of adult patients who started Renal Replacement Therapy (RRT) in Sweden between 1 January 1995, and 31 December 2013. Using uni- and multivariate logistic models, we studied the association between pre-RRT income and education and likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, we also used multivariate Cox proportional hazards regression analysis to assess the association between treatment and socioeconomic factors. Among the 16,215 patients in the sample, 27% had received kidney transplantation by the end of 2013. After adjusting for covariates, the highest income group had more than three times the chance of accessing kidney transplantation compared with patients in the lowest income group (odds ratio (OR): 3.22; 95% confidence interval (CI): 2.73–3.80). Patients with college education had more than three times higher chance of access to kidney transplantation compared with patients with mandatory education (OR: 3.18; 95% CI: 2.77–3.66). Neither living in the county of the transplantation center nor gender was shown to have any effect on the likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, the results from Cox models were similar with what we got from logistic models. Sensitive analyses showed that results were not sensitive to different conditions. Overall, socioeconomic status-related inequities exist in access to kidney transplantation in Sweden. Additional studies are needed to explore the possible mechanisms and strategies to mitigate these inequities.

Highlights

Patients with End-Stage Renal Disease (ESRD) face many challenges, including increased burden of comorbidities, reduced life expectancy and impaired quality of life, compared to general population [1,2]
The international Dialysis Outcomes and Practice Patterns Study (DOPPS) [18] found that income was highly positively associated with access to kidney transplantation education was not when controlling for both variables, which is in contrast to our study
We found that patients with Swedish citizenship had higher chance of access to kidney transplantation compared to non-Swedish patients, which was consistent with a French study [25]

Summary

Introduction

Patients with End-Stage Renal Disease (ESRD) face many challenges, including increased burden of comorbidities, reduced life expectancy and impaired quality of life, compared to general population [1,2]. Renal Replacement Therapy (RRT) are lifesaving treatments which include dialysis and kidney transplantation. Kidney transplantation is generally regarded as the preferred treatment choice compared to dialysis as it extends patients’ life expectancy and improves quality. Res. Public Health 2017, 14, 119; doi:10.3390/ijerph14020119 www.mdpi.com/journal/ijerph

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