title: Are There Inequities in Treatment of End-Stage Renal Disease in Sweden? A Longitudinal Register-Based Study on Socioeconomic Status-Related Access to Kidney Transplantation.
abstract: Socioeconomic status-related factors have been associated with access to kidney transplantation, yet few studies have investigated both individual income and education as determinates of access to kidney transplantation. Therefore, this study aims to explore the effects of both individual income and education on access to kidney transplantation, controlling for both medical and non-medical factors. We linked the Swedish Renal Register to national registers for a sample of adult patients who started Renal Replacement Therapy (RRT) in Sweden between 1 January 1995, and 31 December 2013. Using uni- and multivariate logistic models, we studied the association between pre-RRT income and education and likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, we also used multivariate Cox proportional hazards regression analysis to assess the association between treatment and socioeconomic factors. Among the 16,215 patients in the sample, 27% had received kidney transplantation by the end of 2013. After adjusting for covariates, the highest income group had more than three times the chance of accessing kidney transplantation compared with patients in the lowest income group (odds ratio (OR): 3.22; 95% confidence interval (CI): 2.73-3.80). Patients with college education had more than three times higher chance of access to kidney transplantation compared with patients with mandatory education (OR: 3.18; 95% CI: 2.77-3.66). Neither living in the county of the transplantation center nor gender was shown to have any effect on the likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, the results from Cox models were similar with what we got from logistic models. Sensitive analyses showed that results were not sensitive to different conditions. Overall, socioeconomic status-related inequities exist in access to kidney transplantation in Sweden. Additional studies are needed to explore the possible mechanisms and strategies to mitigate these inequities.
authors.affiliation: Health Economics Unit, Department of Clinical Sciences, Lund University, 22381 Lund, Sweden. ye.zhang@med.lu.se.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Health Economics Unit, Department of Clinical Sciences, Lund University, 22381 Lund, Sweden. johan.jarl@med.lu.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Jarl
authors.affiliation: Health Economics Unit, Department of Clinical Sciences, Lund University, 22381 Lund, Sweden. ulf.gerdtham@med.lu.se.|Department of Economics, Lund University, 22363 Lund, Sweden. ulf.gerdtham@med.lu.se.
authors.forename: Ulf-G
authors.initials: UG
authors.lastname: Gerdtham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D054625:Healthcare Disparities / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000592:standards* / Q000706:statistics & numerical data*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries / Q000592:standards*; D012923:Social Class; D012959:Socioeconomic Factors; D013548:Sweden; D055815:Young Adult
keywords: education; income; inequities; kidney transplantation; socioeconomic factors