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Inequity in access to transplantation in the united kingdom

Lookup NU author(s): Dr Charlie Tomson


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© 2020 by the American Society of Nephrology.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 (n=2676) and listing Within 2 years of starting dialysis (n=1970) by center. 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, includingincreasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, Were associated With a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing Within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants Were both associated With reduced access to preemptive listing; however Asian participants Were associated With a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) Were associated With higher preemptive listing, Whereas using a Written protocol Was associated negatively With listing Within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). 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.

Publication metadata

Author(s): Pruthi R, Robb ML, Oniscu GC, Tomson C, Bradley A, Forsythe JL, Metcalfe W, Bradley C, Dudley C, Johnson RJ, Watson C, Draper H, Fogarty D, Ravanan R, Roderick PJ

Publication type: Article

Publication status: Published

Journal: Clinical Journal of the American Society of Nephrology

Year: 2020

Volume: 15

Issue: 6

Pages: 830-842

Print publication date: 08/06/2020

Online publication date: 08/06/2023

Acceptance date: 24/04/2020

ISSN (print): 1555-9041

ISSN (electronic): 1555-905X

Publisher: American Society of Nephrology


DOI: 10.2215/CJN.11460919

PubMed id: 32467306


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