Recipient's unemployment restricts access to renal transplantation |
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Authors: | Gurprataap S. Sandhu Muhammad Khattak Martha Pavlakis Robert Woodward Douglas W. Hanto Marcy A. Wasilewski Noelle Dimitri Alexander Goldfarb‐Rumyantzev |
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Affiliation: | 1. Department of Internal Medicine, University of Pittsburgh Medical Center, , Pittsburgh, PA, USA;2. University of Massachusetts Memorial Medical Center, , Worcester, MA, USA;3. Transplant Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, , Boston, MA, USA;4. Departments of Health Management and Policy and Economics, University of New Hampshire, , Durham, NH, USA |
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Abstract: | Equitable distribution of a scarce resource such as kidneys for transplantation can be a challenging task for transplant centers. In this study, we evaluated the association between recipient's employment status and access to renal transplantation in patients with end‐stage renal disease (ESRD). We used data from the United States Renal Data System (USRDS). The primary variable of interest was employment status at ESRD onset. Two outcomes were analyzed in Cox model: (i) being placed on the waiting list for renal transplantation or being transplanted (whichever occurred first); and (ii) first transplant in patients who were placed on the waiting list. We analyzed 429 409 patients (age of ESRD onset 64.2 ± 15.2 yr, 55.0% males, 65.1% White). Compared with patients who were unemployed, patients working full time were more likely to be placed on the waiting list/transplanted (HR 2.24, p < 0.001) and to receive a transplant once on the waiting list (HR 1.65, p < 0.001). Results indicate that recipient's employment status is strongly associated with access to renal transplantation, with unemployed and partially employed patients at a disadvantage. Adding insurance status to the model reduces the effect size, but the association still remains significant, indicating additional contribution from other factors. |
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Keywords: | access disparity employment renal allograft transplant waiting list |
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