Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia

Abstract

Socioeconomic disadvantage has been linked to reduced access to kidney transplantation. To understand and address potential barriers to transplantation, we used the Australia and New Zealand Dialysis and Transplant Registry and examined primary kidney-only transplantation among adult non-Indigenous patients who commenced chronic renal replacement therapy in Australia during 2000-2010. Socioeconomic status was derived from residential postcodes using standard indices. Among the 21,190 patients who commenced renal replacement therapy, 4105 received a kidney transplant (2058 from living donors (660 preemptive) or 2047 from deceased donors) by the end of 2010. Compared with the most socioeconomic disadvantaged quartile, patients from the most advantaged quartile were more likely to receive a preemptive transplant (relative rate 1.93), and more likely to receive a living-donor kidney (adjusted subhazard ratio 1.34) after commencing dialysis. Socioeconomic status was not associated with deceased-donor transplantation. Thus, the association between socioeconomic status and living- but not deceased-donor transplantation suggests that potential donors (rather than recipients) from disadvantaged areas may face barriers to donation. Although the deceased-donor organ allocation process appears essentially equitable, it differs between Australian states.

Socio-Economic Status and Peritonitis in Australian Non-Indigenous Peritoneal Dialysis Patients

“…In contrast, SES may be expected to have more impact in countries which require individuals to make significant copayments towards their healthcare, thereby potentially disadvantaging patients from lower SES backgrounds who cannot even afford small out-of-pocket expenses. For example, disadvantaged US citizens are less likely to have insurance, and may face significant out-of-pocket costs for many services (17). Consequently, the observed associations between SES and peritonitis risk may be healthcare system-specific, such that the results of the present study may not be generalizable to other countries with appreciably different healthcare systems.…”

“…Non-normal continuous variables were analyzed using Kruskal-Wallis tests and presented as median (25 th -75 th percentile). Predictors of rates of PD peritonitis were determined by mixed-effects Poisson regression with initial PD hospital treated as a random effect (17). The independent predictors of the clinical outcomes of peritonitis were determined by mixed-effects multivariable binomial logistic regression model with both initial PD hospital and patient treated as random effects.…”

“…Socio-economic status was obtained based on Australian Socio-Economic Indexes for Areas (SEIFA) from the Australian Bureau of Statistics (ABS) (http:// www.abs.gov.au/websitedbs/D3310114.nsf/home/ Seifa_entry_page) similarly to previous investigations (16,17). Socio-Economic Indexes for Areas are summary measures of a number of variables that represent different aspects of relative socio-economic disadvantage and/ or advantage in a geographic area.…”

Socioeconomic Differences in the Uptake of Home Dialysis

“…In 2006, Australian postcodes had a median population of 3323 (interquartile range=788-11,351). Postcodes were placed into quartiles using the Index of Relative Socio-Economic Advantage and Disadvantage (15), similar to previous studies (16,17). This index was produced from 2006 census data on income, education, employment status, occupation type, housing, internet access, disability status, car ownership and single parent status.…”

“…This index was produced from 2006 census data on income, education, employment status, occupation type, housing, internet access, disability status, car ownership and single parent status. Quartiles of postcodes show a linear relationship with employment, income, internet access and unskilled labor (17). Postcodes were also classified as major city or other, based on the Remoteness Areas classification (18 …”