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Socioeconomic inequalities in the kidney transplantation process : A registry-based study in Sweden

Zhang, Ye LU ; Gerdtham, Ulf-G. LU ; Rydell, Helena LU and Jarl, Johan LU (2018) In Transplant Direct 4(2).
Abstract (Swedish)
Socioeconomic Inequalities in the Kidney
Transplantation Process: A Registry-Based
Study in Sweden
Ye Zhang, MSc,
1
Ulf-G. Gerdtham, PhD,
1,2,3
Helena Rydell, MD,
4,5,6
and Johan Jarl, PhD
1
Background.
Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the
kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors.

Methods.
The Swedish Renal Register was linked to national registers for... (More)
Socioeconomic Inequalities in the Kidney
Transplantation Process: A Registry-Based
Study in Sweden
Ye Zhang, MSc,
1
Ulf-G. Gerdtham, PhD,
1,2,3
Helena Rydell, MD,
4,5,6
and Johan Jarl, PhD
1
Background.
Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the
kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors.

Methods.
The Swedish Renal Register was linked to national registers for adult patients in
Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models.

Results.
Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney transplantation. After adjusting for covariates, patients in the highest income quintile were found to have higher access to both the waitlist (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.53-1.96) and kidney transplantation (HR, 1.33; 95% CI, 1.16-1.53) compared with patients in the lowest income quintile. Patients with higher education also had better access to the waitlist and kidney transplantation (HR, 2.16; 95% CI, 1.94-2.40; and HR, 1.16; 95% CI, 1.03-1.30, respectively) compared with patients with mandatory education.

Conclusions.
Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities (Less)
Abstract
Background. Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors. Methods. The Swedish Renal Register was linked to national registers for adult patients in Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models. Results. Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney... (More)
Background. Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors. Methods. The Swedish Renal Register was linked to national registers for adult patients in Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models. Results. Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney transplantation. After adjusting for covariates,patients in the highest income quintile were found to have higher access to both the waitlist (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.53-1.96) and kidney transplantation (HR, 1.33; 95% CI, 1.16-1.53) compared with patients in the lowest incomequintile. Patients with higher education also had better access to the waitlist and kidney transplantation (HR, 2.16; 95% CI, 1.94-2.40; and HR, 1.16; 95% CI, 1.03-1.30, respectively) compared with patients with mandatory education. Conclusions. Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Transplant Direct
volume
4
issue
2
pages
9 pages
ISSN
2373-8731
DOI
10.1097/TXD.0000000000000764
language
English
LU publication?
yes
id
5cf553f9-a771-478b-8ca6-6988cf95cff9
date added to LUP
2018-03-01 21:58:19
date last changed
2018-06-01 03:00:26
@article{5cf553f9-a771-478b-8ca6-6988cf95cff9,
  abstract     = {<b>Background. </b>Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors. <b>Methods. </b>The Swedish Renal Register was linked to national registers for adult patients in Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models.<b> Results.</b> Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney transplantation. After adjusting for covariates,patients in the highest income quintile were found to have higher access to both the waitlist (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.53-1.96) and kidney transplantation (HR, 1.33; 95% CI, 1.16-1.53) compared with patients in the lowest incomequintile. Patients with higher education also had better access to the waitlist and kidney transplantation (HR, 2.16; 95% CI, 1.94-2.40; and HR, 1.16; 95% CI, 1.03-1.30, respectively) compared with patients with mandatory education. <b>Conclusions. </b>Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities.},
  articleno    = {e346},
  author       = {Zhang, Ye and Gerdtham, Ulf-G. and Rydell, Helena and Jarl, Johan},
  issn         = {2373-8731},
  language     = {eng},
  month        = {01},
  number       = {2},
  pages        = {9},
  series       = {Transplant Direct},
  title        = {Socioeconomic inequalities in the kidney transplantation process : A registry-based study in Sweden},
  url          = {http://dx.doi.org/10.1097/TXD.0000000000000764},
  volume       = {4},
  year         = {2018},
}