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Socioeconomic Status and Kidney Transplant Outcomes in a Universal Healthcare System: A Population-based Cohort Study
- Source :
- Transplantation. 103(5)
- Publication Year :
- 2018
-
Abstract
- Background Conflicting evidence exists regarding the relationship between socioeconomic status (SES) and outcomes after kidney transplantation. Methods We conducted a population-based cohort study in a publicly funded healthcare system using linked administrative healthcare databases from Ontario, Canada to assess the relationship between SES and total graft failure (ie, return to chronic dialysis, preemptive retransplantation, or death) in individuals who received their first kidney transplant between 2004 and 2014. Secondary outcomes included death-censored graft failure, death with a functioning graft, all-cause mortality, and all-cause hospitalization (post hoc outcome). Results Four thousand four hundred-fourteen kidney transplant recipients were included (median age, 53 years; 36.5% female), and the median (25th, 75th percentile) follow-up was 4.3 (2.1-7.1) years. In an unadjusted Cox proportional hazards model, each CAD $10000 increase in neighborhood median income was associated with an 8% decline in the rate of total graft failure (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.87-0.97). After adjusting for recipient, donor, and transplant characteristics, SES was not significantly associated with total or death-censored graft failure. However, each CAD $10000 increase in neighborhood median income remained associated with a decline in the rate of death with a functioning graft (adjusted (a)HR, 0.91; 95% CI, 0.83-0.98), all-cause mortality (aHR, 0.92; 95% CI, 0.86-0.99), and all-cause hospitalization (aHR, 0.95; 95% CI, 0.92-0.98). Conclusions In conclusion, in a universal healthcare system, SES may not adversely influence graft health, but SES gradients may negatively impact other kidney transplant outcomes and could be used to identify patients at increased risk of death or hospitalization.
- Subjects :
- Adult
Graft Rejection
Male
Percentile
medicine.medical_specialty
Databases, Factual
Population
030230 surgery
03 medical and health sciences
0302 clinical medicine
Universal Health Insurance
Internal medicine
Outcome Assessment, Health Care
medicine
Humans
Mortality
education
Socioeconomic status
Kidney transplantation
Ontario
Transplantation
education.field_of_study
Proportional hazards model
business.industry
Hazard ratio
Health Status Disparities
Middle Aged
medicine.disease
Kidney Transplantation
Confidence interval
Hospitalization
Social Class
Kidney Failure, Chronic
030211 gastroenterology & hepatology
Female
business
Cohort study
Follow-Up Studies
Subjects
Details
- ISSN :
- 15346080
- Volume :
- 103
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Transplantation
- Accession number :
- edsair.doi.dedup.....f2260ef94358d46784b510251379c652