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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

Zhang, Ye LU ; Jarl, Johan LU and Gerdtham, Ulf G. LU (2017) In International Journal of Environmental Research and Public Health 14(2).
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... (More)

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.

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author
organization
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type
Contribution to journal
publication status
published
subject
keywords
Education, Income, Inequities, Kidney transplantation, Socioeconomic factors
in
International Journal of Environmental Research and Public Health
volume
14
issue
2
publisher
Multidisciplinary Digital Publishing Institute (MDPI)
external identifiers
  • scopus:85011092209
  • wos:000395467900011
ISSN
1661-7827
DOI
10.3390/ijerph14020119
language
English
LU publication?
yes
id
f7b38627-a9b4-4b45-a958-39629375233e
date added to LUP
2017-02-14 11:12:33
date last changed
2018-01-07 11:49:40
@article{f7b38627-a9b4-4b45-a958-39629375233e,
  abstract     = {<p>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.</p>},
  articleno    = {119},
  author       = {Zhang, Ye and Jarl, Johan and Gerdtham, Ulf G.},
  issn         = {1661-7827},
  keyword      = {Education,Income,Inequities,Kidney transplantation,Socioeconomic factors},
  language     = {eng},
  month        = {02},
  number       = {2},
  publisher    = {Multidisciplinary Digital Publishing Institute (MDPI)},
  series       = {International Journal of Environmental Research and Public Health},
  title        = {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},
  url          = {http://dx.doi.org/10.3390/ijerph14020119},
  volume       = {14},
  year         = {2017},
}