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Inequity in access to transplantation in the UK
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On Behalf of the ATTOM Investigators (Including: Pruthi, Rishi, Robb, Matthew L., Oniscu, Gabriel C., Tomson, Charles R. V., Bradley, Andrew, Forsythe, John L., Metcalfe, Wendy, Bradley, Clare, Dudley, Christopher, Johnson, Rachel J., Watson, Christopher, Draper, Heather, Fogarty, Damian, Ravanan, Rommel and Roderick, Paul J.). (2020) Inequity in access to transplantation in the UK. Clinical Journal of the American Society of Nephrology, 15 (6). pp. 830-842. doi:10.2215/CJN.11460919 ISSN 1555-9041.
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Official URL: https://doi.org/10.2215/CJN.11460919
Abstract
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, including increasing 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.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
| Library of Congress Subject Headings (LCSH): | Kidneys -- Transplantation, Kidneys -- Transplantation -- Patients -- Great Britain, Kidneys -- Transplantation -- Great Britain, Health services accessibility -- Great Britain, Equality -- Health aspects -- Great Britain | ||||||
| Journal or Publication Title: | Clinical Journal of the American Society of Nephrology | ||||||
| Publisher: | American Society of Nephrology | ||||||
| ISSN: | 1555-9041 | ||||||
| Official Date: | 8 June 2020 | ||||||
| Dates: |
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| Volume: | 15 | ||||||
| Number: | 6 | ||||||
| Page Range: | pp. 830-842 | ||||||
| DOI: | 10.2215/CJN.11460919 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||
| Copyright Holders: | Copyright © 2020 by the American Society of Nephrology | ||||||
| Date of first compliant deposit: | 30 April 2020 | ||||||
| Date of first compliant Open Access: | 30 April 2020 | ||||||
| RIOXX Funder/Project Grant: |
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