A new approach for measuring gender disparity in access to renal transplantation waiting lists.
BACKGROUND
Gender inequity in access to renal transplantation waiting lists, in favor of men, has long since been demonstrated in a number of studies. Discrepancies between the results of the available studies might be explained by different analytical approaches or different national contexts. In this study we analyzed French end-stage renal disease registry data using a novel model to determine whether the female gender is associated with a lower probability of being listed on the transplant waiting list or with a longer time from dialysis start until registration, or both.


METHODS
The effect of gender on access to the national renal transplantation waiting list was assessed in 9497 men and 5386 women aged 18 to 74 years who started dialysis between 2002 and 2009. We used a semiparametric regression cure model adjusted for age, work status, and 11 comorbidities or disabilities.


RESULTS
Women were younger and less likely to work or have associated comorbidities. At the study endpoint, 33.8% of the men and 34.1% of the women were placed on the renal transplantation waiting list. After taking potential confounders into account, our model shows that women demonstrated a lower probability of being registered on the national transplant waiting list (odds ratio=0.69; 95% confidence interval, 0.62-0.78) and a longer time from dialysis start to registration (hazard ratio=0.89; 95% confidence interval, 0.84-0.95) than men. This disparity affects predominantly older women who do not work or have diabetes and is more pronounced in some geographic areas.


CONCLUSIONS
These poorly understood gender-based inequities require further consideration.
REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France. cecile.couchoud@biomedecine.fr
Cécile
C
Couchoud
Sahar
S
Bayat
Emmanuel
E
Villar
Christian
C
Jacquelinet
René
R
Ecochard
D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D012042:Registries; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014850:Waiting Lists; D055815:Young Adult