Journal article
The Interplay of Socioeconomic Status, Distance to Center, and Interdonor Service Area Travel on Kidney Transplant Access and Outcomes
Clinical journal of the American Society of Nephrology, Vol.5(12), pp.2276-2288
12/01/2010
DOI: 10.2215/CJN.04940610
PMCID: PMC2994090
PMID: 20798250
Abstract
Background and objectives: Variation in kidney transplant access across the United States may motivate relocation of patients with ability to travel to better-supplied areas.
Design, setting, participants, & measurements: We examined national transplant registry and U.S. Census data for kidney transplant candidates listed in 1999 to 2009 with a reported residential zip code (n = 203,267). Cox's regression was used to assess associations of socioeconomic status (SES), distance from residence to transplant center, and relocation to a different donation service area (DSA) with transplant access and outcomes.
Results: Patients in the highest SES quartile had increased access to transplant compared with those with lowest SES, driven strongly by 76% higher likelihood of living donor transplantation (adjusted hazard ratio [aHR] 1.76, 95% confidence interval [CI] 1.70 to 1.83). Waitlist death was reduced in high compared with low SES candidates (aHR 0.86, 95% CI 0.84 to 0.89). High SES patients also experienced lower mortality after living and deceased donor transplant. Patients living farther from the transplant center had reduced access to deceased donor transplant and increased risk of post-transplant death. Inter-DSA travel was associated with a dramatic increase in deceased donor transplant access (HR 1.94, 95% CI 1.88 to 2.00) and was predicted by high SES, white race, and longer deceased-donor allograft waiting time in initial DSA.
Conclusions: Ongoing disparities exist in kidney transplantation access and outcomes on the basis of geography and SES despite near-universal insurance coverage under Medicare. Inter-DSA travel improves access and is more common among high SES candidates. Clin J Am Soc Nephrol 5: 2276-2288, 2010 doi: 10.2215/CJN.04940610
Details
- Title: Subtitle
- The Interplay of Socioeconomic Status, Distance to Center, and Interdonor Service Area Travel on Kidney Transplant Access and Outcomes
- Creators
- David A. Axelrod - Dartmouth–Hitchcock Medical CenterNino Dzebisashvili - Saint Louis UniversityMark A. Schnitzler - Saint Louis UniversityPaolo R. Salvalaggio - University of WashingtonDorry L. Segev - Saint Louis UniversitySommer E. Gentry - United States Naval AcademyJanet Tuttle-Newhall - Saint Louis UniversityKrista L. Lentine - Saint Louis University
- Resource Type
- Journal article
- Publication Details
- Clinical journal of the American Society of Nephrology, Vol.5(12), pp.2276-2288
- Publisher
- Amer Soc Nephrology
- DOI
- 10.2215/CJN.04940610
- PMID
- 20798250
- PMCID
- PMC2994090
- ISSN
- 1555-9041
- eISSN
- 1555-905X
- Number of pages
- 13
- Grant note
- Hitchcock Foundation RC1 1RC1DK086450-01; K08DK073036 / National Institute of Diabetes Digestive and Kidney Diseases (NIDDK); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) RC1DK086450 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 12/01/2010
- Academic Unit
- Surgery
- Record Identifier
- 9984322926202771
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