title: Social deprivation, ethnicity, and uptake of living kidney donor transplantation in the United Kingdom.
abstract: BACKGROUND
  Socioeconomic disparities and their contribution to the ethnic differences in living kidney donor transplantation have not been adequately studied.
  
  
  METHODS
  A total of 12,282 patients aged 18 to 69 years starting renal replacement therapy (January 1, 1997, to December 31, 2004) in the United Kingdom were included. Logistic regression models were used to examine probability of living donor transplantation within 3 years of renal replacement therapy. The effect of area deprivation (Townsend index) was studied among whites only adjusted for patient characteristics and the effect of ethnic origin (South Asians and blacks compared with whites) was then examined among all patients adjusting for area deprivation.
  
  
  RESULTS
  Among whites, increasing social deprivation was associated with lower odds of living donor transplantation. In the fully adjusted model, odds ratio (OR) for the most deprived quintile was 0.40 (95% confidence interval [CI] 0.33, 0.49; P trend<0.0001) compared with the least deprived. These gradients were more pronounced among centers performing more live donor transplants (P value for interaction <0.0001). South Asians and blacks had lower odds of living donor transplantation compared with whites, but there was an interaction with age (P<0.0001), so that this disparity was observed only in those younger than 50 years (blacks: OR, 0.31; 95% CI, 0.18, 0.54; South Asians: OR, 0.55; 95% CI, 0.34, 0.90; P value <0.0001).
  
  
  CONCLUSIONS
  Socially deprived and younger ethnic minority patients have lower probability of living kidney donor transplantation. The extent to which these inequalities reflect modifiable societal healthcare system barriers and donor/recipient factors requires further study.
authors.affiliation: U.K. Renal Registry, Southmead Hospital, Bristol, UK. udaya.udayaraj@nbt.nhs.uk
authors.forename: Udaya
authors.initials: U
authors.lastname: Udayaraj
authors.forename: Yoav
authors.initials: Y
authors.lastname: Ben-Shlomo
authors.forename: Paul
authors.initials: P
authors.lastname: Roderick
authors.forename: Anna
authors.initials: A
authors.lastname: Casula
authors.forename: Chris
authors.initials: C
authors.lastname: Dudley
authors.forename: Dave
authors.initials: D
authors.lastname: Collett
authors.forename: David
authors.initials: D
authors.lastname: Ansell
authors.forename: Charles
authors.initials: C
authors.lastname: Tomson
authors.forename: Fergus
authors.initials: F
authors.lastname: Caskey
mesh_terms: D000328:Adult; D000367:Age Factors; D044466:Asian People / Q000208:ethnology; D044383:Black People / Q000208:ethnology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D051437:Renal Insufficiency / Q000453:epidemiology / Q000208:ethnology* / Q000601:surgery*; D012189:Retrospective Studies; D012923:Social Class; D006113:United Kingdom / Q000453:epidemiology; D044465:White People / Q000208:ethnology