Social deprivation, ethnicity, and access to the deceased donor kidney transplant waiting list in England and Wales.
BACKGROUND
Socioeconomic and ethnic inequity in access to kidney transplant waiting list has been described in the United States but not examined in a universal healthcare system.


METHODS
Eleven thousand two hundred ninety-nine patients aged 18 to 69 years starting renal replacement therapy (January 1, 1997 to December 31, 2004) in England and Wales were included. Multivariable Cox proportional hazards models were used to assess time to activation on the transplant waiting list for socially deprived patients among white patients. The effect of ethnic origin (South Asians and blacks compared with whites) was examined among all patients.


RESULTS
Among white patients, in the fully adjusted model, the hazard ratio (HR) for the most deprived quintile was 0.60 (95% confidence interval [CI] 0.54-0.68, P trend <0.0001) compared with the least deprived. Deprivation effects were more pronounced among those 50 years and older (P value for interaction <0.0001). Non-whites had a lower risk of being waitlisted than whites (for blacks: HR 0.89, 95% CI 0.79-1.01; for South Asians: HR 0.91, 95% CI 0.83-0.99, P value for heterogeneity=0.03). These differences were attenuated in a fully adjusted model. However non-whites who were 50 years and older were more likely to be transplant waitlisted than whites (interaction P=0.002).


CONCLUSIONS
Individuals living in socially deprived areas have reduced access to the transplant waiting list. Understanding the reasons for this apparent inequity is important if we wish to ensure equitable access to renal transplants. There were no major differences by ethnicity, and if anything, older white patients were less likely to be waitlisted.
Udayaraj
Udaya
U
UK Renal Registry, Southmead Hospital, Bristol, Avon, United Kingdom. udaya.udayaraj@nbt.nhs.uk
Ben-Shlomo
Yoav
Y
Roderick
Paul
P
Casula
Anna
A
Dudley
Chris
C
Johnson
Rachel
R
Collett
Dave
D
Ansell
David
D
Tomson
Charles
C
Caskey
Fergus
F
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D004739:England; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016030:Kidney Transplantation / Q000208:ethnology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D011203:Poverty; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012923:Social Class; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D014850:Waiting Lists; D014852:Wales; D055815:Young Adult