Renal transplantation outcome and social deprivation in the French healthcare system: a cohort study using the European Deprivation Index

Abstract

The study objective was to estimate the effect of social deprivation estimated by the European Deprivation Index (EDI) on the risk of death and graft failure on renal transplantation in France. EDI was calculated for 8701 of 9205 patients receiving a first renal transplantation between 2010 and 2014. Patients were separated in EDI quintiles of the general population. A Cox model (cs-HR: cause-specific hazard ratio of death or graft failure) and a Fine and Gray model (sd-HR: subdistribution hazard ratio of death and graft failure) were used for the analysis. The 5th quintile group (most deprived) accounted for 32% of patients [2818 of 8701]. In the multivariate analysis, compared with quintile 1, the risk of death was higher for the 5 quintile group in the complete cohort [cs-HR: 1.31, 95% CI: (1.01-1.70), sd-HR: 1.29, 95% CI: (1.00-1.68)], in the deceased donor group [cs-HR: 1.31, 95% CI: (1.00-1.71), sd-HR: 1.30, 95% CI: (1.00-1.70)] but not in living donor transplant patients. There was no association between the EDI groups and the risk of transplant failure. Social deprivation estimated by the EDI is associated with an increased risk of death in transplantation in France but not with the chance of allograft loss.

Social deprivation is associated with poor kidney transplantation outcome in children

“…The EDI has been validated and successfully compared with other ecological indexes of deprivation. 27,28 It also already has been used in adult nephrology studies, 29 as well as in cancer studies. 30,31 However, even if the EDI has been validated and is restricted to a small geographic area (Ilots Regroupés pour l'Information Statistique [IRIS]), a possible ecological bias remains.…”

Housing Insecurity and Risk of Adverse Kidney Outcomes

“…We treated cumulative financial resource strain as a continuous score to be consistent with past studies using measures of resource strain. 45,46 However, we were not able to measure the relative weight or significance of each measure in the score, which may differ for each individual. Additional studies are needed to determine the best way to measure and analyze this variable.…”

“Upstream medicine”: targeting social determinants of health in transplant care

“…This challenges the view that the vast majority of transplant outcomes result primarily from patient characteristics, the treatment regimen, and/or transplant center practice patterns. As a result, social deprivation is receiving growing attention regarding the variability of transplant outcomes .…”

“…In this month's Journal, Chatelet et al . report on how they used that index to assess social deprivation in renal transplantation. Their study included 94% of all renal transplant recipients in France who received first transplants between 2010 and 2014.…”

“…In contrast to previous studies elsewhere, social deprivation was not a risk factor for graft loss in France . Considering that the French healthcare system provides excellent health insurance coverage regarding end‐stage renal disease and renal transplantation, this finding suggests that policy measures linked to extensive healthcare coverage contribute to favorable outcomes in at‐risk groups .…”