Influence of Socio-Economic Inequalities on Access to Renal Transplantation and Survival of Patients with End-Stage Renal Disease

Wahida Kihal-Talantikite , Cécile Vigneau (1, 2) , Séverine Deguen (3, 4) , Muriel Siebert (2) , Cécile Couchoud (5) , Sahar Bayat (6, 4)

1 IGDR - Institut de Génétique et Développement de Rennes
2 Service de néphrologie [Rennes]
3 Irset - Institut de recherche en santé, environnement et travail
4 EHESP - École des Hautes Études en Santé Publique [EHESP]
5 Registre REIN
6 METIS - Département Méthodes quantitatives en santé publique

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

Domains: Life Sciences [q-bio]; Santé publique et épidémiologie; Life Sciences [q-bio]; Human health and pathology; Urology and Nephrology; Life Sciences [q-bio]; Human health and pathology; Surgery

Wahida Kihal-Talantikite, Cécile Vigneau, Séverine Deguen, Muriel Siebert, Cécile Couchoud, et al.. Influence of Socio-Economic Inequalities on Access to Renal Transplantation and Survival of Patients with End-Stage Renal Disease. PLoS ONE, 2016, 11 (4), pp.e0153431. ⟨10.1371/journal.pone.0153431⟩. ⟨hal-01305481⟩