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PLoS One. 2016 Apr 15;11(4):e0153431. doi: 10.1371/journal.pone.0153431. eCollection 2016.

Influence of Socio-Economic Inequalities on Access to Renal Transplantation and Survival of Patients with End-Stage Renal Disease.

Author information

1
EHESP School of Public Health, Sorbonne Paris Cité, Rennes, France.
2
CHU Pontchaillou, Service de néphrologie, Rennes, France.
3
Université de Rennes 1, UMR 6290, équipe Kyca, Rennes, France.
4
REIN Registry, Agence de la biomédecine, Saint Denis La Plaine, France.
5
EHESP School of Public Health, Sorbonne Paris Cité, EA MOS, Rennes, France.

Abstract

BACKGROUND:

Public and scientific concerns about the social gradient of end-stage renal disease and access to renal replacement therapies are increasing. This study investigated the influence of social inequalities on the (i) access to renal transplant waiting list, (ii) access to renal transplantation and (iii) patients' survival.

METHODS:

All incident adult patients with end-stage renal disease who lived in Bretagne, a French region, and started dialysis during the 2004-2009 period were geocoded in census-blocks. To each census-block was assigned a level of neighborhood deprivation and a degree of urbanization. Cox proportional hazards models were used to identify factors associated with each study outcome.

RESULTS:

Patients living in neighborhoods with low level of deprivation had more chance to be placed on the waiting list and less risk of death (HR = 1.40 95%CI: [1.1-1.7]; HR = 0.82 95%CI: [0.7-0.98]), but this association did not remain after adjustment for the patients' clinical features. The likelihood of receiving renal transplantation after being waitlisted was not associated with neighborhood deprivation in univariate and multivariate analyses.

CONCLUSIONS:

In a mixed rural and urban French region, patients living in deprived or advantaged neighborhoods had the same chance to be placed on the waiting list and to undergo renal transplantation. They also showed the same mortality risk, when their clinical features were taken into account.

PMID:
27082113
PMCID:
PMC4833352
DOI:
10.1371/journal.pone.0153431
[Indexed for MEDLINE]
Free PMC Article

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