Inequity Found in Access to Transplant With Universal Health Care

FRIDAY, May 29, 2020 (HealthDay News) — Patient factors account for much of the variation in access to kidney transplantation in the United Kingdom, according to a study published online May 28 in the Clinical Journal of the American Society of Nephrology.

Rishi Pruthi, Ph.D., from Guy’s and St. Thomas’ National Health Service Foundation Trust in London, and colleagues conducted a prospective observational cohort study at 72 U.K. kidney centers to assess equity in access to kidney transplantation in the presence of a universal health care system. Incident renal replacement therapy (RRT) patients were analyzed to assess preemptive listing and listing within two years of starting dialysis.

The researchers found that 26 percent of 2,676 incident RRT patients were preemptively listed, while 30 percent of 1,970 patients starting dialysis were listed within two years of dialysis initiation. Increasing age, most comorbidities, body mass index >35 kg/m², and lower socioeconomic status were patient factors associated with reduced likelihood of being listed and accounted for much of the intercenter variation. There were inconsistent associations seen for ethnic minority, while reduced access was only observed for preemptive listing. Transplanting center status and a universal approach to discussing transplantation was associated with higher preemptive listing (odds ratios, 3.1 and 1.4, respectively).

“Findings from the United Kingdom make it apparent that barriers to transplantation are not limited to the availability of health care coverage,” write the authors of an accompanying editorial.

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