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Ulf Gerdtham. Photo.

Ulf Gerdtham

Professor

Ulf Gerdtham. Photo.

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

Author

  • Ye Zhang
  • Ulf-G. Gerdtham
  • Helena Rydell
  • Johan Jarl

Summary, in English

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.

Department/s

  • Health Economics
  • Department of Clinical Sciences, Lund
  • Department of Economics
  • Centre for Economic Demography
  • Nephrology
  • EpiHealth: Epidemiology for Health

Publishing year

2018-01-24

Language

English

Publication/Series

Transplant Direct

Volume

4

Issue

2

Document type

Journal article

Publisher

Wolters Kluwer

Topic

  • Health Care Service and Management, Health Policy and Services and Health Economy

Status

Published

Research group

  • Health Economics

ISBN/ISSN/Other

  • ISSN: 2373-8731