Interaction between socioeconomic deprivation and likelihood of pre‐emptive transplantation: influence of competing risks and referral characteristics – a retrospective study

Gillis, K. A. , Lees, J. S. , Ralston, M. R., Glen, J. A., Stevenson, K. S., McManus, S. K., Geddes, C. C., Clancy, M., Traynor, J. P. and Mark, P. B. (2019) Interaction between socioeconomic deprivation and likelihood of pre‐emptive transplantation: influence of competing risks and referral characteristics – a retrospective study. Transplant International, 32(2), pp. 153-162. (doi: 10.1111/tri.13336) (PMID:30152890)

Abstract

Socioeconomic deprivation (SED) influences likelihood of pre‐emptive kidney transplantation (PET), but the mechanisms behind this are unclear. We explored the relationships between SED and patient characteristics at referral, which might explain this discrepancy. A retrospective cohort study was performed. SED was measured by Scottish Index of Multiple Deprivation (SIMD). Logistic regression evaluated predictors of PET. A competing risks survival analysis evaluated the interaction between SED and progression to end‐stage kidney disease (ESKD) and death. Of 7765 patients with follow‐up of 5.69 ± 6.52 years, 1298 developed ESKD requiring RRT; 113 received PET, 64 of which were from live donors. Patients receiving PET were “less deprived” with higher SIMD (5 ± 7 vs. 4 ± 5; P = 0.003). This appeared independent of overall comorbidity burden. SED was associated with a higher risk of death but not ESKD. Higher SIMD decile was associated with a higher likelihood of PET (OR 1.14, 95% CI 1.06, 1.23); the presence of diabetes and malignancy also reduced PET. SED was associated with reduced likelihood of PET after adjustment for baseline comorbidity, and this was not explained by risk of death or faster progression to ESKD. Education and outreach into transplantation should be augmented in areas with higher deprivation.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lees, Jennifer and Clancy, Mr Marc and Mark, Professor Patrick and Gillis, Dr Keith and Ralston, Dr Maximilian
• Authors: Gillis, K. A., Lees, J. S., Ralston, M. R., Glen, J. A., Stevenson, K. S., McManus, S. K., Geddes, C. C., Clancy, M., Traynor, J. P., and Mark, P. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Transplant International
• Publisher: Wiley
• ISSN: 0934-0874
• ISSN (Online): 1432-2277
• Published Online: 28 August 2018
• Copyright Holders: Copyright © 2018 Steunstichting ESOT
• First Published: First published in Transplant International 32(2): 153-162
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher