title: The influence of socioeconomic deprivation on outcomes following renal transplantation in the United kingdom.
abstract: Socio-economic deprivation is an important determinant of poor health and is associated with a higher incidence of end-stage renal disease, higher mortality for dialysis patients and lower chance of being listed for transplantation. The influence of deprivation on outcomes following renal transplantation has not previously been reported in the United Kingdom. The Welsh Index of Multiple Deprivation was used to assess the influence of socio-economic deprivation on outcomes for 621 consecutive renal transplant recipients from a single centre in the United Kingdom transplanted between 1997 and 2005. Outcomes measured were rate of acute rejection and graft survival. Patients from the most deprived areas were significantly more likely to experience an episode of acute rejection requiring treatment (36% vs. 27%, p=0.01) and increasing overall deprivation correlated with increasing rates of rejection (p=0.03). Income deprivation was significantly and independently associated with graft survival (HR 1.484, p=0.046). Among patients who experienced acute rejection 5-year graft survival was 79% for those from the most deprived areas compared with 90% for patients from the least deprived areas (p = 0.018). Overall socio-economic deprivation is associated with higher rate of acute rejection following renal transplantation and income deprivation is a significant and independent predictor of graft survival.
authors.affiliation: University Hospital of Wales, Cardiff, UK. mikestephens@doctors.org.uk
authors.forename: M R
authors.initials: MR
authors.lastname: Stephens
authors.forename: M
authors.initials: M
authors.lastname: Evans
authors.forename: M A
authors.initials: MA
authors.lastname: Ilham
authors.forename: A
authors.initials: A
authors.lastname: Marsden
authors.forename: A
authors.initials: A
authors.lastname: Asderakis
mesh_terms: D004522:Educational Status; D004777:Environment; D006084:Graft Rejection / Q000453:epidemiology; D006297:Health Services Accessibility; D006798:Housing / Q000592:standards; D006801:Humans; D007182:Income; D007676:Kidney Failure, Chronic / Q000191:economics; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics*; D011203:Poverty; D006435:Renal Dialysis / Q000191:economics / Q000401:mortality; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014478:Unemployment / Q000706:statistics & numerical data; D006113:United Kingdom; D014850:Waiting Lists; D014852:Wales