Major Inequalities Research Articles

Predictors of Cardiac Rehabilitation Utilization in England: Results From the National Audit.

BackgroundCardiac rehabilitation (CR) is grossly underused, with major inequities in access. However, use of CR and predictors of initiation in England where CR contracting is available is unknown. The aims were (1) to investigate CR utilization rates in England, and (2) to determine sociodemographic and clinical factors associated with CR initiation including social deprivation.Methods and ResultsData from the National Audit of CR, between January 2012 and November 2015, were used. Utilization rates overall and by deprivation quintile were derived. Logistic regression was performed to identify predictors of initiation among enrollees, using the Huber–White–sandwich estimator robust standard errors method to account for the nested nature of the data. Of the 234 736 (81.5%) patients referred to CR, 141 648 enrolled, 97 406 initiated CR, and of those initiating, 37.2% completed a program of ≥8 weeks duration. The significant characteristics associated with CR initiation were younger age (odds ratio [OR] 0.98, 95% CI 0.98–0.99), having a partner (OR 1.31, 95% CI 1.17–1.48), not being employed (OR 0.86, 95% CI 0.77–0.96), not having diabetes mellitus (OR 0.84, 95% CI 0.77–0.92), greater anxiety (OR 1.02, 95% CI 1.003–1.04), not being a medically managed myocardial infarction patient (OR 0.57, 95% CI 0.42–0.76), and having had coronary artery bypass graft surgery (OR 1.64, 95% CI 1.09–2.47).Conclusions CR enrollment does not meet English National Health Service targets; however it compares with that in other countries. Evidence‐based approaches increasing CR enrollment and initiation should be applied, focusing on the identified characteristics associated with CR initiation, specifically older, single, employed individuals with diabetes mellitus and those not revascularized.

“Just Another Story”

Since 1972, when the U.S. Congress passed Title IX, girls’ and women’s participation in sport exponentially increased. Yet, major gender inequities remain, including in media coverage. Feminist sports media scholars have pointed to journalists’ resistance toward Title IX as one explanation for these inequities. To further examine the relationship between Title IX and coverage of women’s sport, this study draws upon oral history interviews with 14 sports journalists who worked at newspapers in one major media market in the United States before and after the implementation of Title IX. In their memories, journalists incorporated two dominant cultural narratives: conflict narratives, which position gains in women’s sports against losses in men’s sports, and celebratory narratives, which uncritically embrace Title IX as a catalyst for girls and women in sport. Although all agreed that Title IX had a positive impact upon women’s sports, few believed Title IX actually changed coverage. This study points to the limitations of applying Title IX’s gender equity framework to sports journalism and calls for a reassessment in advocacy efforts toward gender justice.

Health of sexual minorities in north-eastern Brazil: representations, behaviours and obstacles

Objective: The aim of this study was to identify the social representations (SR) of health and major inequities, obstacles and challenges experienced by lesbians, gays, bisexuals, and transgenders regarding access to health services. Methods: This qualitative research was conducted with a group of sexual minorities recruited using the snowball technique. The data were organised according to Bardin and analysed from the perspective of SR. Results: Twelve gays, nine transvestites, six lesbians and three bisexuals participated. Most believed health to be the absence of disease and indicated the group’s vulnerability to sexually transmitted diseases. The search for health services was motivated by pathological symptoms or screening for sexually transmitted diseases. The diffi culties were related to the defi ciencies of the health service regarding prejudice. Conclusions: The study population showed reductionist health representations, sought health services under the curative perspective and faced challenges/obstacles when accessing health services.

Challenges faced by gender-variant people in receiving appropriate care and ways to improve their care and lives – A UK study

IntroductionIt is only in the last decade that trans people have been accorded rights and give protection in law from discrimination. A survey of 10,000 people undertaken by the Equality and Human Right Commission showed that 1% of the population was gender-variant to some extent. Gender-variant people continue to suffer restricted opportunities, discrimination and harassment at work despite the existence of anti-discrimination and equalities legislation. It is estimated that up to 40% of people with gender dysphoria may not be receiving appropriate help.ObjectiveReview of UK policies, guidelines, legislation and research on challenges faced by gender-variant people and ways to improve their care and lives.AimsTo improve gender-variant people access to care and ways to fight inequalities.MethodsMEDLINE, PsycINFO databases were searched for articles published between 2005–2015 containing the keywords “gender dysphoria”, “gender-variant people” and “transgender people”. Relevant policies, guidelines and legislations were also reviewed.ResultsTransgender people still face major health inequalities and discrimination. National statistics show that 80% have experienced harassment, 62% suffered discrimination at work or home and 54% reported being denied access to NHS care due to lack of cultural competency from staff. Guidelines, research, policies and equality legislation have begun to be implemented to protect transgender people from discrimination and accord rights.ConclusionsMany areas need attention and improvement including not only healthcare but also employment, education, housing and media perception. Promotion of equality in the general population with the aim of achieving cultural change and improvement of cultural competency of health professionals is needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Assuring quality education and learning: Lessons from Education for All

This introduction highlights the main focus of this special issue, Assuring Quality Education and Learning: Lessons from Education for All. The 2015 Education for All Global Monitoring Report (GMR)—Education for All 2000–2015: Achievements and Challenges—underlines the fact that inadequate attention to education of good quality and a failure to reach the marginalized have contributed to a learning crisis that needs urgent attention. Based on selected background papers for the 2015 GMR, this special issue takes stock of the achievements and challenges of the past 15 years through nine comprehensive articles. A key message that emerged from the 2015 GMR is that major social and economic inequalities act as powerful obstacles to progress in education. Those left behind are the most marginalized and vulnerable. Moving forward, better opportunities for schooling must be available to all children and youth, regardless of family background, gender, or disability. As such, educational reform cannot rest on technical solutions alone. Strategies for learning are most effective when they develop strong links with existing community priorities.

Promoção da saúde, qualidade de vida e iniquidade em saúde: reflexões para a saúde pública.

A ideia de promover saúde tem se tornado uma energia fundamental no movimento de saúde coletiva, no qual saúde é um fenômeno social e marcado por iniquidades. Este trabalho teve como objetivo compreender as relações entre promoção da saúde e iniquidades de acesso e assistência em saúde, identificandoos entraves para uma prática equânime da saúde pública com ênfase à qualidade de vida. Os diferentes perfis de doença e suas mediações sociais ultrapassam os estudos de variação biológica e incorpora o foco na dimensão social das vulnerabilidades. Para promover saúde no Brasil, é indissociável do enfrentamento de uma realidade de iniquidades históricas de grandes proporções que impõem desafios cotidianos não apenas ao setor de saúde, mas a todos aqueles que constroem políticas públicas. A qualidade de vida depende da satisfação das necessidades básicas de todos os cidadãos, propondo uma gestão baseada na solidariedade social, uma visão holística dos problemas e a redução das iniquidades. A promoção da saúde em um país tão desigual como o Brasil propõe um desafio constante aos atores envolvidos no sistema de saúde. A compreensão das iniquidades em saúde para estabelecer uma assistência holística é um processo difícil, mas extremamente relevante para a saúde pública.

Confronting environmental quality and societal aspects: an environmental Kuznets curve analysis for Indian cities

Ever-growing problems of environmental degradation can be attributed to the inequality scenarios arising from the prevalent socio-economic imbalances and two of the major inequalities for the case of India in this regard are inequality in energy intensity and economic inequality. In this paper, we have taken the ambient air pollution data for 139 cities in India for the duration of 2001-2013, where sulphur dioxide (SO2) and nitrogen dioxide (NO2) have been chosen as the major air pollutants. Based on the empirical evidence, it can be found that interactions between inequality and societal aspects have significant contributions towards determining environmental quality. The paper concludes that any environmental policy cannot function effectively unless it takes other developmental policies into consideration. Leaving socio-economic parameters aside, the enhancement of environmental quality can prove to be extremely difficult to achieve, the evidence of which can be found from an analysis of Indian cities.

Moving on: How depressive symptoms, social support, and health behaviors predict residential mobility.

There are major health inequalities between residential areas. However, it remains unclear whether these inequalities are due to social causation or selective residential mobility, because little is known about the associations between health-related factors and selective residential mobility. This study examined how depressive symptoms, social support, and health behaviors are associated with subsequent residential mobility, as measured by frequency, distance, and direction of moves. Participants were selected from the Young Finns prospective cohort study (N = 3017) with four study waves in 1992, 1997, 2001, and 2007. Complete residential mobility history was gathered for each participant from registry data. Residential mobility was assessed over three-year periods following each study wave. The direction of mobility was measured as changes in residential location's population density, health index, mortality index, and unemployment. Area characteristics were used as covariates together with the participants' age, sex, and education. Individuals reporting higher social support from friends were more likely to move (b = 0.20; 95% confidence interval (CI): 0.08, 0.37) and move more frequently (b = 0.08; 95% CI: 0.01, 0.14), whereas individuals reporting higher social support from their family members were less likely to move (b = -0.08; 95% CI: -0.14, -0.02). Better health behaviors were associated with longer moving distances (b = 0.14; 95% CI: 0.06, -0.23). None of the individual characteristics were associated with the direction of moves as measured by changes in municipality characteristics. CONCLUSIONS SOME OF THE HEALTH-RELATED CHARACTERISTICS ARE ASSOCIATED WITH RESIDENTIAL MOBILITY IN FINLAND HOWEVER, THESE INDIVIDUAL CHARACTERISTICS DO NOT SEEM TO PREDICT SYSTEMATIC SELECTIVE RESIDENTIAL MOBILITY ACROSS MUNICIPALITIES WITH DIFFERENT REGIONAL HEALTH PROFILES.

Beyond the networks: Self-help services and post-settlement network extensions in the periphery of Dar es Salaam

This paper offers insights from comprehensive case studies of rapidly growing peripheral settlements of Dar es Salaam. The paper explores how a broad range of services and infrastructures have developed and improved over time, and how residents have been engaged in this in various ways. The gradual improvements in services and infrastructure are to some extent created, organized and financed by residents through informal self-help solutions, which are often costly and place huge strains on residents' time and resources. Alongside this, residents are also involved in attracting formal service providers through applications, co-financing of network extensions as well as lobbying efforts towards urban authorities and service providers. The formal service providers primarily take a reactive role, responding to demand, requests and political pressure from residents. Post-settlement network extensions are often complicated and impeded by costly and cumbersome land-acquisition processes, and because of the reactive and often piecemeal approach to network extensions, society may be missing out on potential benefits of scale. The way urban services work also means that the provision of services and infrastructure is extremely differentiated and fragmented across the urban territory, creating and reinforcing major inequalities in access to services.

Towards Equality and Equity in Education : Assessing an Initiative to Strengthen Teacher Professional Development in South Africa

In South Africa major educational inequalities and disparities in education are prevalent at especially historically black township schools due to the country’s history and current contexts. Teacher training evolved from the apartheid system which was characterised by deep racial and regional inequalities with poor teacher training and low admission requirements for blacks. Most currently serving teachers received their professional education from the apartheid system which adversely impacts on national assessments and equitable teaching and learning. The poor performance of learners from township schools in national and international literacy assessments prompted the Gauteng Department of Education (GDE) to take proactive teacher professional development (TPD) steps to address the issue of equitable teaching and learning and chronic learner underperformance in literacy in the province. This strategy to address equality and equitable learning through TPD is called the Gauteng Province Literacy and Mathematics Strategy (GPLMS). The study examines the effect of the practicing teacher professional development (TPD) on Grade 3 teachers’ understanding and experiences of the implementation of the GPLMS in selected underperforming schools in the Gauteng Province of South Africa. Data on the importance and results of the programme as well as support for the GPLMS were gathered using interviews, document analysis and observation. The mentoring process stood out as the most important contributing factor for effective implementation of the GPLMS. Respondents reflected positive attitudes towards school-based Literacy teacher professional development. The fast pace of the programme, large classes, marking and lack of parental involvement were major challenges. Despite these challenges the new GPLMS provided more equitable teaching and learning opportunities and it improved the literacy assessment levels of the learners.

Carr, D.Worried Sick: How Stress Hurts Us and How to Bounce Back. New Brunswick, NJ: Rutgers University Press. 2014116pp £12.99 (pbk) ISBN 978‐0813565378

Worried Sick is an odd little book. I was intrigued by it, and having read it, I confess to being unsure how to begin my review, apart from to assert that it is an odd book. This slim volume comes from the Rutgers University Press ‘PinPoints’ series on ‘Complex Topics, Concise Explanations’. This may explain its unconventional approach and form. The four other texts in the series include a book on Black icons and others on the economy of New Jersey, environmental crisis and water shortage, and dark matter. Set against these titles Worried Sick looks unusual, but not incongruous. The PinPoints brief is to deliver material for ‘a wide circle of scholars, students and non-specialist general readers’ in 100 pages and Carr sticks to these page limits. And as to content, well, it was interesting to read a book on stress not written by a health psychologist or from a psychotherapeutic stance. Deborah Carr is a Professor of Sociology at Rutgers where she teaches and conducts research on family life and the effects of stressors such as bereavement, so I wondered if a sociologist's fresh examination of the topic would contradict biomedical explanations of stress and our responses to it. In as much as this is possible in such a short book, Carr does this. In essence, the book presents a biopsychosocial (BPS) model that highlights the interconnectedness of biology, psychological, economic and social factors that create and may protect against stress. As a side note, David Pilgrim (2015) has written about the popularity of BPS amongst health researchers that provides a fuller account and critique of this model. Carr's book straddles the popular science, self-help and introductory sociology genres such that it is not always clear who the actual audience will be. Worried Sick might find its way to the mind/body section of the book store, where the sub-title promise of ‘bounce back’ solutions might not be misplaced, but I was not sure quite how comfortably it would fit in the sociology or health sections. Questions of product placement aside, the book is a good summary of the topic and an interesting, quick read. The book ‘feels’ very American, in part because of Carr's attempts to personalise the message with vignettes and stories about ‘Dawn’, ‘Naomi’, ‘Marisol’ and ‘Rob’ in the manner of populist therapy books. This is reinforced by evidence drawn from US sources, learning that ‘16% of Americans have ever suffered from a major depressive disorder’ (p. 25) and 18% of them have experienced anxiety in the past year (p. 27). It was not until half way through that a study of ‘ninety thousand adults in the United Kingdom’ – linking mental state and mortality – was mentioned (p. 50), but this was not referenced, making the book a slightly frustrating academic resource. Carr provides an outline of the historical definitions of stress, going back to Hans Selye's endocrinological research in the 1950s, and reviewing contemporary measures and scales, but also noting ideas about stress contagion in social networks. She reviews, albeit briefly, various theories about the links between stress and health - covering role strain, cumulative disadvantage, stress process and discrepancy theories - and contrasts these with bio-genetic explanations for the complex relationship between mind and body. Carr mentions survey and laboratory experimental research methods before examining ‘social science explanations’ for the connection between stress and health. There are a couple of pages each on (damaging) heath behaviours, nudges to alter these, and the impact of sleep on mental wellbeing. This precedes a section on ‘Social Class: The Fundamental Cause Behind the Stress-Health Link’ which briefly takes in fundamental cause theory and the impact of social inequality, before the book returns to Seyle's physiological work. The fourth and penultimate chapter examines ideas about risk and resilience, and the conclusion explores ‘Paths to Healing’. This notes the benefits of social support for behaviour change, alongside cognitive behavioural therapy and mindfulness. There is a relatively short section on medications, which – given their ubiquity and cost, and interest to social scientists – might have warranted a longer and more critical appraisal. That said, Carr concludes that ‘most of the stressors discussed in this book have their roots in major social inequalities based on one's social class, race, gender, age or even body size’ (p. 108) and argues that public and social policy can support these stressors, or address them to improve population wellbeing. That seems to be a message worth repeating.

Social Media and the “20 Cents Movement” in Brazil: What Lessons Can Be Learnt from This?

The scope of this article is to describe and analyze the “20 Cents Movement” in Brazil that flared up in June 2013, as well as the important role the social network sites played in spreading this unrest nationwide. The Internet and social media context in Brazil is set forth and the brief history of the “20 Cents Movement” is unveiled. The dynamics of these uprisings in Brazil is then examined and interpreted in order to understand how important social media were in fomenting this movement. Lastly, lessons learnt and recommendations for policy-makers are outlined such that they can better understand the consequences and unexpected ripple effects arising from the intense use of social network sites in nations marked by major social, economic, political and digital inequalities.

Different Needs or Treated Differently? Understanding Ethnic Inequalities in Coronary Revascularisation Rates

Several studies have reported major ethnic inequalities in cardiac revascularisation. This paper attempts to explain why in New Zealand, Māori and Pacific patients may be less likely to receive cardiac revascularisation interventions than Europeans. Angiograms of 55 Māori, 45 Pacific and 100 age-sex matched European patients with ST elevation myocardial infarction were reviewed by two cardiologists blinded to the patients' ethnicity to determine ethnic differences in actual and recommended revascularisation likelihood. Māori and Pacific patients were 18% (95% C.I. 6%-29%) less likely to receive cardiac revascularisation procedures compared to European patients. If intervention had been based on the recommendation from blinded angiogram review they would have been 14% (2%-24%) less likely to receive revascularisation. Māori and Pacific were significantly more likely to be recommended for CABG (RR=2.9; C.I. 1.4-5.8) and less likely for PCI (RR=0.60; 0.48-0.75). Māori and Pacific were at significantly higher risk of under-treatment overall (RR=5.0; 1.1-22.8) and for CABG (RR=8.0; 1.0-64.0), but not for PCI (RR=2.0; 0.2-22.1). However these relative risks became non-significant when cases not eligible for surgery due to comorbidities were excluded. Māori and especially Pacific STEMI patients present with a pattern of ischaemic heart disease that is less amenable to PCI, even after allowing for differences in the number of diseased vessels and diabetes prevalence. The lower likelihood of Māori and Pacific patients receiving recommended CABG is largely explained by higher comorbidity prevalence.

Access to health care in Dakar (Senegal): frequency, type of provider, and non-communicable chronic diseases

(1) To describe access to health care in the population of Dakar; (2) to analyze the influence of socioeconomic and demographic characteristics on access to health care; (3) and to describe the fraction of consultations accounted for by chronic non-communicable diseases. These data come from a 2009 survey of 600 individuals aged 20 years and over. Socioeconomic and demographic characteristics and information about access to health care were collected. Chi-square tests and binary logistic regressions were used for the statistical analyses. Men, people with no schooling, and poor people were underrepresented among users of health care services. Moreover, the majority of Dakar residents who sought health care during the year preceding the survey went to see a doctor (as opposed to a traditional healer, pharmacist, nurse, midwife, or dentist). Finally, chronic diseases accounted for the smallest fraction of reasons for medical consultations; they were mentioned most often by those aged 50 years or older who consult more than 5 times a year. Dakar residents have an access to health care similar to that of people in other African countries, but this conclusion hides major inequalities. Moreover, at the same time that Senegal is undergoing an epidemiological transition, chronic non-communicable diseases are not a major reason for consultations. The epidemiological projections made for Africa for the next 15 years indicate that the development of strategies to avert the development of these diseases in Senegal must be a priority objective.

Under-diagnosis of myocardial infarction in women

Major inequalities exist between men and women in the treatment and outcome of acute coronary syndromes with women being less likely to have a diagnosis of myocardial infarction (MI).

Construction of points realizing the regular systems of Wolfgang Schmidt and Leonard Summerer

Récemment, W. M. Schmidt et L. Summerer ont introduit une nouvelle théorie qui leur permet de redémontrer les principales inégalités connues liant les exposants d’approximation diophantienne d’un point de ℝ n , et d’en trouver de nouvelles. Ils montrent d’abord comment la plupart de ces exposants peuvent être calculés en termes des minima successifs d’une famille de convexes à un paramètre attachée à ce point. Puis ils démontrent que ces minima peuvent, à leur tour, être approchés par une certaine classe de fonctions dites de type (n,γ). Ils ramènent ainsi le problème initial à l’étude de ces fonctions. Pour compléter la théorie, on voudrait savoir si, en retour, étant donné une fonction de ce type, il existe un point de ℝ n dont les minima de la famille de convexes correspondante approchent cette fonction. On montre ici que tel est le cas pour les fonctions dites régulières.

Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases.

Neglected Tropical Diseases (NTDs) are both drivers and manifestations of poverty and social inequality. Increased advocacy efforts since the mid-2000s have led to ambitious new control and elimination targets set for 2020 by the World Health Organisation. While these global aspirations represent significant policy momentum, there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged, understood and engaged. However a number of recent publications have emphasised the “neglected” status of applied social science research on NTDs. In light of the 2020 targets, this paper explores the social science/NTD literature and unpacks some of the ways in which social inquiry can help support effective and sustainable interventions. Five priority areas are discussed, including on policy processes, health systems capacity, compliance and resistance to interventions, education and behaviour change, and community participation. The paper shows that despite the multifaceted value of having anthropological and sociological perspectives integrated into NTD programmes, contemporary efforts underutilise this potential. This is reflective of the dominance of top-down information flows and technocratic approaches in global health. To counter this tendency, social research needs to be more than an afterthought; integrating social inquiry into the planning, monitoring and evaluating process will help ensure that flexibility and adaptability to local realities are built into interventions. More emphasis on social science perspectives can also help link NTD control to broader social determinants of health, especially important given the major social and economic inequalities that continue to underpin transmission in endemic countries.Electronic supplementary materialThe online version of this article (doi:10.1186/2049-9957-3-35) contains supplementary material, which is available to authorized users.

A critical analysis of the National Norms and Standards for School Funding policy

Assessment of the legacy of apartheid at the end of the apartheid era in South Africa highlighted major inequalities between white and black, urban and rural areas, and several departments of education. Eighteen years into democracy, the country needs to distinguish between the initiatives taken by the government to address the apartheid legacy, the actual changes made in education and the results thereof, and the continuities and discontinuities in education. Historically disadvantaged schools now receive larger state funding (no-fee schools) and school fee exemptions are granted to lower income or unemployed parents who find difficulty in paying school fees for their children, regardless of race. The public schooling system, especially township schools, is still characterized by low pass rates, low teacher and learner morale, a resurgence of violence amongst learners, ineffective leadership by school managers, poor governance by school governing boards and generally declining school quality, efficiency and effectiveness. The purpose of this paper is to interrogate the National Norms and Standards for School Funding (NNSSF) policy, in order to assess whether this post-apartheid government policy has succeeded in addressing social justice and equity in public primary and secondary education

Building on Tinto’s model of engagement and persistence: Experiences from the Umthombo Youth Development Foundation Scholarship Scheme

Background. Major inequalities in staffing levels at rural and urban hospitals contribute to poorer health outcomes in rural areas. Local and international studies have shown that healthcare professionals (HCPs) of rural origin are more likely than those of urban origin to work in and contribute to improved health outcomes in rural areas. However, absent role models, dysfunctional families, schools that perform poorly and inadequate funding make it almost impossible for rural-origin students to gain access to institutions of higher learning (IHLs) to train as HCPs. Objective. To present the experiences of graduates from the Umthombo Youth Development Foundation Scholarship Scheme, build on Tinto’s model of persistence and engagement, and contribute towards the success rates of rural-origin HCPs. Methods. This qualitative study used a life-history methodology. Unstructured interviews, photomemory, artefacts and collage development were used to explore the educational experiences of six rural-origin HCPs. Data were coded and categorised and themes identified. Results. Compulsory academic and peer mentoring promoted academic and social engagement, helped students to recognise their pre-university experiences as generative, and contributed to their success. The generative potential of pre-university experiences and compulsory work-based experiential learning were identified as initiatives that could strengthen Tinto’s model of persistence and engagement. Conclusion. A number of targeted interventions, if introduced at South African IHLs, could contribute to improved success rates of rural-origin health science students.

Rapid access to renal transplant waiting list in children: impact of patient and centre characteristics in France.

Major inequalities in access to renal transplant waiting lists have been demonstrated among adult patients both in the USA and Europe. In this French nationwide study, we sought to ascertain the influence of patient and centre characteristics. We included all children (<18 years) in the French End-Stage Renal Disease National Registry, who started renal replacement therapy (RRT) between 1 January 2002 and 31 December 2011. The primary outcome was the probability of being listed within 6 months after starting RRT. Hierarchical logistic regression models were used to study the association between the patient or the centre characteristics and the outcome. Centre effects were assessed by studying the centre-level residual variance. A total of 614 incident patients treated in 54 centres were included; 421 (68.6%) were listed within 6 months after starting RRT. A higher risk of not being listed was found in patients younger than 2 years or with a renal disease with a high risk of recurrence after transplantation [odds ratio (OR): 2.61; 95% confidence interval (CI): 1.37-4.97]. We found a significant vintage effect: the probability of not being listed decreased over time (OR per 1 year +0.83, 95% CI: 0.74-0.94). Although we found no significant gender effect, a trend towards disfavouring girls persisted over the study period. We found a significant centre effect that remained after adjusting for patient characteristics. However, none of the centre characteristics that we studied (centre size, pre-emptive transplantation program, paediatric versus adult centres and the proportion of patients on the waiting list placed on inactive status during the first month after listing) explained this variability. Our study confirms inequalities among children in rapid access to the renal transplant waiting list and shows that patient and centre characteristics play a role in these inequalities. Further studies focusing on the organization and practices of the centres are needed to explain the remaining variability.