Social Deprivation and Incidence of Pediatric Kidney Failure in France

Abstract

IntroductionApproximately 8 per million children and young adults aged < 20 initiate kidney replacement therapy (KRT) per year in France. We hypothesize that social deprivation could be a determinant of childhood-onset kidney failure. The objective of this study was to estimate the incidence of pediatric KRT in France according to the level of social deprivation. MethodsAll patients < 20 years who initiated KRT from 2010 to 2015 in metropolitan France were included. Data were collected from the comprehensive French registry of KRT (REIN). We used a validated ecological index to assess social deprivation, the 2011 French version of the European Deprivation Index (EDI). We estimated the age-standardized incidence rates according to the quintiles of EDI using direct standardization and incidence rate ratio (IRR) using Poisson regression. ResultsWe included 672 children with kidney failure (58.6% males, 30.7% with glomerular or vascular disease, 43.3% starting KRT between 11 and 17 years). 38.8% were from the most deprived areas (quintile 5 of EDI). The age-standardized incidence rate increased with quintile of EDI, from 5.45 (95% CI 4.25-6.64) per million children per year in the least deprived quintile to 8.46 (95% CI 7.41-9.51) in the most deprived quintile of EDI (IRR Q5 vs Q1 1.53 95% CI 1.18-2.01). ConclusionThis study showed that even in a country with a universal healthcare system, there is a strong association between the incidence of pediatric KRT and social deprivation showing that social health inequalities appear from KRT initiation. This study highlights the need to look further into social inequalities in the earliest stage of CKD.