title: Residence location and likelihood of kidney transplantation.
abstract: BACKGROUND
  In a universal, public health care system, access to kidney transplantation should not be influenced by residence location. We determined the likelihood of kidney transplantation from deceased donors among Canadian dialysis patients living in 7 geographic regions. Within each region we also determined whether distance from the closest transplant centre was associated with the likelihood of transplantation.
  
  
  METHODS
  A random sample of 7034 subjects initiating dialysis in Canada between 1996 and 2000 was studied. We used Cox proportional hazards models to examine the relation between residence location and the likelihood of kidney transplantation from deceased donors over a median period of 2.4 years.
  
  
  RESULTS
  There were significant differences in the likelihood of kidney transplantation from deceased donors and predicted waiting times between the different geographic regions. For example, the adjusted relative likelihood of transplantation in Alberta was 3.74 (95% confidence interval [CI] 2.95-4.76) compared with the likelihood in Ontario (p < 0.001). These differences persisted after further adjustment for differences in the rate of deceased organ donation. Within regions, patients who resided 50.1-150 km, 150.1-300 km and more than 300 km from the closest transplant centre had a similar adjusted likelihood of receiving a kidney transplant as those who lived less than 50 km away.
  
  
  CONCLUSIONS
  The adjusted likelihood of undergoing a kidney transplant from a deceased donor varied substantially between geographic regions in Canada. In contrast, the likelihood of transplantation within regions was not affected by distance from the closest transplant centre.
authors.affiliation: Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Alta. mtonelli@ualberta.ca
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Scott
authors.initials: S
authors.lastname: Klarenbach
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: Bruce
authors.initials: B
authors.lastname: Culleton
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.forename: Stefania
authors.initials: S
authors.lastname: Bertazzon
authors.forename: Natasha
authors.initials: N
authors.lastname: Wiebe
authors.forename: John S
authors.initials: JS
authors.lastname: Gill
mesh_terms: D000368:Aged; D002102:Cadaver; D002170:Canada; D003956:Dialysis; D005260:Female; D005843:Geography; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D014850:Waiting Lists