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Social deprivation and survival on renal replacement therapy in England and Wales

Social deprivation and survival on renal replacement therapy in England and Wales
Social deprivation and survival on renal replacement therapy in England and Wales
This study examines the association between social deprivation and patient characteristics and outcomes in a nationally representative cohort of incident renal replacement therapy (RRT) patients. All Caucasian patients reported to the UK Renal Registry between 1997 and 2004 by centers in England and Wales with high data completeness were included. Social deprivation was assessed using the Townsend index. Socially deprived patients were more likely to be referred late. They were less likely to receive peritoneal dialysis (25.1 vs 34.8% on day 1, P trend <0.0001) or a renal transplant (5.3 vs 12.4% at 1 year, P trend <0.0001), and were less likely to attain UK Renal Association standards for hemoglobin and phosphate at 1 year. Crude survival decreased significantly with increasing deprivation for patients under the age of 65 years, but not for those aged 65 years and above (likelihood ratio for age-social deprivation interaction P<0.0001). Social deprivation was significantly associated with poorer survival after adjustment for age, gender, and cause of renal failure. After adjusting for baseline co-morbidity, social deprivation was no longer associated with poorer survival. Baseline differences in co-morbidity seem to explain poorer crude survival in incident Caucasian RRT patients from socially deprived areas in England and Wales. Differences also exist in some processes of care and intermediate outcomes, which may be amenable to intervention.
end-stage renal disease, epidemiology and outcomes, survival
0085-2538
2134-2140
Caskey, F.J.
ebe2c431-e2f3-4ca0-aff7-ab6a5fabaf75
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Steenkamp, R.
2747774c-cb75-4ea4-bf5f-fb10a6978ce6
Nitsch, D .
18356b51-1626-4a72-945a-e0606dffaac5
Thomas, K.
1e0ab734-0f20-42a1-9bb6-64aa0a3cff9d
Ansell, D.
4849c1d3-9ff9-46ac-91e5-b4c6d7a6b52f
Feest, T.
35e86351-7682-448a-817c-759561797c80
Caskey, F.J.
ebe2c431-e2f3-4ca0-aff7-ab6a5fabaf75
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Steenkamp, R.
2747774c-cb75-4ea4-bf5f-fb10a6978ce6
Nitsch, D .
18356b51-1626-4a72-945a-e0606dffaac5
Thomas, K.
1e0ab734-0f20-42a1-9bb6-64aa0a3cff9d
Ansell, D.
4849c1d3-9ff9-46ac-91e5-b4c6d7a6b52f
Feest, T.
35e86351-7682-448a-817c-759561797c80

Caskey, F.J., Roderick, P., Steenkamp, R., Nitsch, D ., Thomas, K., Ansell, D. and Feest, T. (2006) Social deprivation and survival on renal replacement therapy in England and Wales. Kidney International, 70 (12), 2134-2140. (doi:10.1038/sj.ki.5001999).

Record type: Article

Abstract

This study examines the association between social deprivation and patient characteristics and outcomes in a nationally representative cohort of incident renal replacement therapy (RRT) patients. All Caucasian patients reported to the UK Renal Registry between 1997 and 2004 by centers in England and Wales with high data completeness were included. Social deprivation was assessed using the Townsend index. Socially deprived patients were more likely to be referred late. They were less likely to receive peritoneal dialysis (25.1 vs 34.8% on day 1, P trend <0.0001) or a renal transplant (5.3 vs 12.4% at 1 year, P trend <0.0001), and were less likely to attain UK Renal Association standards for hemoglobin and phosphate at 1 year. Crude survival decreased significantly with increasing deprivation for patients under the age of 65 years, but not for those aged 65 years and above (likelihood ratio for age-social deprivation interaction P<0.0001). Social deprivation was significantly associated with poorer survival after adjustment for age, gender, and cause of renal failure. After adjusting for baseline co-morbidity, social deprivation was no longer associated with poorer survival. Baseline differences in co-morbidity seem to explain poorer crude survival in incident Caucasian RRT patients from socially deprived areas in England and Wales. Differences also exist in some processes of care and intermediate outcomes, which may be amenable to intervention.

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More information

Published date: 2006
Keywords: end-stage renal disease, epidemiology and outcomes, survival

Identifiers

Local EPrints ID: 46220
URI: https://eprints.soton.ac.uk/id/eprint/46220
ISSN: 0085-2538
PURE UUID: 17978d0d-0023-4be4-bd23-1e8b039fae34
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 05 Jun 2007
Last modified: 14 Mar 2019 01:52

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