title: Influence of Socio-Economic Inequalities on Access to Renal Transplantation and Survival of Patients with End-Stage Renal Disease.
abstract: BACKGROUND
  Public and scientific concerns about the social gradient of end-stage renal disease and access to renal replacement therapies are increasing. This study investigated the influence of social inequalities on the (i) access to renal transplant waiting list, (ii) access to renal transplantation and (iii) patients' survival.
  
  
  METHODS
  All incident adult patients with end-stage renal disease who lived in Bretagne, a French region, and started dialysis during the 2004-2009 period were geocoded in census-blocks. To each census-block was assigned a level of neighborhood deprivation and a degree of urbanization. Cox proportional hazards models were used to identify factors associated with each study outcome.
  
  
  RESULTS
  Patients living in neighborhoods with low level of deprivation had more chance to be placed on the waiting list and less risk of death (HR = 1.40 95%CI: [1.1-1.7]; HR = 0.82 95%CI: [0.7-0.98]), but this association did not remain after adjustment for the patients' clinical features. The likelihood of receiving renal transplantation after being waitlisted was not associated with neighborhood deprivation in univariate and multivariate analyses.
  
  
  CONCLUSIONS
  In a mixed rural and urban French region, patients living in deprived or advantaged neighborhoods had the same chance to be placed on the waiting list and to undergo renal transplantation. They also showed the same mortality risk, when their clinical features were taken into account.
authors.affiliation: EHESP School of Public Health, Sorbonne Paris Cité, Rennes, France.
authors.forename: Wahida
authors.initials: W
authors.lastname: Kihal-Talantikite
authors.affiliation: CHU Pontchaillou, Service de néphrologie, Rennes, France.|Université de Rennes 1, UMR 6290, équipe Kyca, Rennes, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Vigneau
authors.affiliation: EHESP School of Public Health, Sorbonne Paris Cité, Rennes, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Deguen
authors.affiliation: CHU Pontchaillou, Service de néphrologie, Rennes, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Siebert
authors.affiliation: REIN Registry, Agence de la biomédecine, Saint Denis La Plaine, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.affiliation: EHESP School of Public Health, Sorbonne Paris Cité, EA MOS, Rennes, France.
authors.forename: Sahar
authors.initials: S
authors.lastname: Bayat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult