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Inequity in access to transplantation in the United Kingdom

Inequity in access to transplantation in the United Kingdom
Inequity in access to transplantation in the United Kingdom

Background and objectives Despite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess Whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns. Design, setting, participants, & measurements In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study Were analyzed to assess preemptive listing (n=2676) and listing Within 2 years of starting dialysis (n=1970) by center. Results Seven hundred and six participants (26%) Were listed preemptively, Whereas 585 (30%) Were listed Within 2 years of commencing dialysis. The interquartile range across centers Was 6%–33% for preemptive listing and 25%–40% for listing after starting dialysis. Patient factors, includingincreasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, Were associated With a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing Within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants Were both associated With reduced access to preemptive listing; however Asian participants Were associated With a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) Were associated With higher preemptive listing, Whereas using a Written protocol Was associated negatively With listing Within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). Conclusions Patient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, With practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system.

1555-9041
830-842
Pruthi, Rishi
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Robb, Matthe W.L.
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Oniscu, Gabriel C.
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Tomson, Charles
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Bradley, Andrew
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Forsythe, John L.
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Metcalfe, Wendy
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Bradley, Clare
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Dudley, Christopher
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Johnson, Rachel J.
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watson, Christopher
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Draper, Heather
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Fogarty, Damian
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Ravanan, Rommel
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Roderick, Paul J.
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ATTOM investigators
Pruthi, Rishi
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Robb, Matthe W.L.
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Oniscu, Gabriel C.
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Tomson, Charles
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Bradley, Andrew
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Forsythe, John L.
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Metcalfe, Wendy
dcad3fd9-b47d-415a-aeca-97db8d212b88
Bradley, Clare
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Dudley, Christopher
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Johnson, Rachel J.
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watson, Christopher
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Draper, Heather
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Fogarty, Damian
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Ravanan, Rommel
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Roderick, Paul J.
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Pruthi, Rishi, Robb, Matthe W.L., Oniscu, Gabriel C., Tomson, Charles, Bradley, Andrew, Forsythe, John L., Metcalfe, Wendy, Bradley, Clare, Dudley, Christopher, Johnson, Rachel J., watson, Christopher, Draper, Heather, Fogarty, Damian, Ravanan, Rommel and Roderick, Paul J. , ATTOM investigators (2020) Inequity in access to transplantation in the United Kingdom. Clinical Journal of the American Society of Nephrology, 15 (6), 830-842. (doi:10.2215/CJN.11460919).

Record type: Article

Abstract

Background and objectives Despite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess Whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns. Design, setting, participants, & measurements In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study Were analyzed to assess preemptive listing (n=2676) and listing Within 2 years of starting dialysis (n=1970) by center. Results Seven hundred and six participants (26%) Were listed preemptively, Whereas 585 (30%) Were listed Within 2 years of commencing dialysis. The interquartile range across centers Was 6%–33% for preemptive listing and 25%–40% for listing after starting dialysis. Patient factors, includingincreasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, Were associated With a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing Within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants Were both associated With reduced access to preemptive listing; however Asian participants Were associated With a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) Were associated With higher preemptive listing, Whereas using a Written protocol Was associated negatively With listing Within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). Conclusions Patient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, With practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system.

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Accepted/In Press date: 24 April 2020
e-pub ahead of print date: 8 June 2020
Published date: June 2020

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Local EPrints ID: 443491
URI: http://eprints.soton.ac.uk/id/eprint/443491
ISSN: 1555-9041
PURE UUID: 9d2c7eb8-9920-42e8-9598-83a0a454b304
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 26 Aug 2020 16:36
Last modified: 10 Jan 2022 02:37

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Contributors

Author: Rishi Pruthi
Author: Matthe W.L. Robb
Author: Gabriel C. Oniscu
Author: Charles Tomson
Author: Andrew Bradley
Author: John L. Forsythe
Author: Wendy Metcalfe
Author: Clare Bradley
Author: Christopher Dudley
Author: Rachel J. Johnson
Author: Christopher watson
Author: Heather Draper
Author: Damian Fogarty
Author: Rommel Ravanan
Corporate Author: ATTOM investigators

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