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Limited health literacy is associated with reduced access to kidney transplantation

Limited health literacy is associated with reduced access to kidney transplantation
Limited health literacy is associated with reduced access to kidney transplantation
Limited health literacy is common in patients with chronic kidney disease (CKD) and has been variably associated with adverse clinical outcomes. The prevalence of limited health literacy is lower in kidney transplant recipients than in individuals starting dialysis, suggesting selection of patients with higher health literacy for transplantation. We investigated the relationship between limited health literacy and clinical outcomes, including access to kidney transplantation, in a prospective UK cohort study of 2,274 incident dialysis patients aged 18-75 years. Limited health literacy was defined by a validated Single Item Literacy Screener (SILS). Multivariable regression was used to test for association with outcomes after adjusting for age, sex, socioeconomic status (educational level and car ownership), ethnicity, first language, primary renal diagnosis, and comorbidity. In fully adjusted analyses, limited health literacy was not associated with mortality, late presentation to nephrology, dialysis modality, haemodialysis vascular access, or pre-emptive kidney transplant listing, but was associated with reduced likelihood of listing for a deceased-donor transplant (hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.51-0.90), receiving a living-donor transplant (HR 0.41; 95% CI 0.19-0.88), or receiving a transplant from any donor type (HR 0.65; 95% CI 0.44-0.96). Limited health literacy is associated with reduced access to kidney transplantation, independent of patient demographics, socioeconomic status, and comorbidity. Interventions to ameliorate the effects of low health literacy may improve access to kidney transplantation.
0085-2538
1244-1252
Taylor, Dominic
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Bradley, J. Andrew
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Bradley, Clare
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Draper, Heather
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Dudley, Christopher
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Fogarty, Damian G.
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Fraser, Simon
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Johnson, Rachel
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Leydon, Geraldine
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Metcalfe, Wendy
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Oniscu, Gabriel C.
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Robb, Matthew
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Tomson, Charles
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Watson, Christopher J.E.
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Ravanan, Rommel
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Roderick, Paul
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ATTOM investigators
Taylor, Dominic
d5431234-2e04-4888-b61f-d86b01b65679
Bradley, J. Andrew
b4741218-b899-4a19-a9a3-4ad41969e81f
Bradley, Clare
35f55ae9-4f28-4c20-9266-a8640c6406fa
Draper, Heather
d3efb1a7-0556-4685-8c4b-482a29de0f96
Dudley, Christopher
8635192a-7c9f-43ad-a7c8-7f5ee91651b2
Fogarty, Damian G.
51dd186b-6e59-4a60-a1b6-69cde26410c2
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Johnson, Rachel
7bddbae0-022e-49db-916e-082f61586498
Leydon, Geraldine
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Metcalfe, Wendy
dcad3fd9-b47d-415a-aeca-97db8d212b88
Oniscu, Gabriel C.
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Robb, Matthew
fc558d84-af0b-427f-bacf-1d6cc5efdadd
Tomson, Charles
d9044890-5faf-4d0c-b685-5cfa41929c44
Watson, Christopher J.E.
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Ravanan, Rommel
478a10c3-977c-448e-8551-1437edba2acd
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a

Taylor, Dominic, Bradley, J. Andrew, Bradley, Clare, Draper, Heather, Dudley, Christopher, Fogarty, Damian G., Fraser, Simon, Johnson, Rachel, Leydon, Geraldine, Metcalfe, Wendy, Oniscu, Gabriel C., Robb, Matthew, Tomson, Charles, Watson, Christopher J.E., Ravanan, Rommel and Roderick, Paul , ATTOM investigators (2019) Limited health literacy is associated with reduced access to kidney transplantation. Kidney International, 95 (5), 1244-1252. (doi:10.1016/j.kint.2018.12.021).

Record type: Article

Abstract

Limited health literacy is common in patients with chronic kidney disease (CKD) and has been variably associated with adverse clinical outcomes. The prevalence of limited health literacy is lower in kidney transplant recipients than in individuals starting dialysis, suggesting selection of patients with higher health literacy for transplantation. We investigated the relationship between limited health literacy and clinical outcomes, including access to kidney transplantation, in a prospective UK cohort study of 2,274 incident dialysis patients aged 18-75 years. Limited health literacy was defined by a validated Single Item Literacy Screener (SILS). Multivariable regression was used to test for association with outcomes after adjusting for age, sex, socioeconomic status (educational level and car ownership), ethnicity, first language, primary renal diagnosis, and comorbidity. In fully adjusted analyses, limited health literacy was not associated with mortality, late presentation to nephrology, dialysis modality, haemodialysis vascular access, or pre-emptive kidney transplant listing, but was associated with reduced likelihood of listing for a deceased-donor transplant (hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.51-0.90), receiving a living-donor transplant (HR 0.41; 95% CI 0.19-0.88), or receiving a transplant from any donor type (HR 0.65; 95% CI 0.44-0.96). Limited health literacy is associated with reduced access to kidney transplantation, independent of patient demographics, socioeconomic status, and comorbidity. Interventions to ameliorate the effects of low health literacy may improve access to kidney transplantation.

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Taylor_HL_KI - Accepted Manuscript
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More information

Accepted/In Press date: 20 December 2018
e-pub ahead of print date: 2 April 2019
Published date: May 2019

Identifiers

Local EPrints ID: 430337
URI: http://eprints.soton.ac.uk/id/eprint/430337
ISSN: 0085-2538
PURE UUID: 58919be0-ef6b-49ef-bc04-a014f78a7944
ORCID for Simon Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 25 Apr 2019 16:30
Last modified: 10 Jan 2022 02:54

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Contributors

Author: Dominic Taylor
Author: J. Andrew Bradley
Author: Clare Bradley
Author: Heather Draper
Author: Christopher Dudley
Author: Damian G. Fogarty
Author: Simon Fraser ORCID iD
Author: Rachel Johnson
Author: Wendy Metcalfe
Author: Gabriel C. Oniscu
Author: Matthew Robb
Author: Charles Tomson
Author: Christopher J.E. Watson
Author: Rommel Ravanan
Author: Paul Roderick ORCID iD
Corporate Author: ATTOM investigators

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