Socioeconomic dependency and kidney transplantation accessibility and outcomes: a nationwide observational cohort study
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ORIGINAL ARTICLE
Socioeconomic dependency and kidney transplantation accessibility and outcomes: a nationwide observational cohort study in South Korea Sehoon Park1,2 · Jina Park3 · Myoungsuk Kim3 · Ji Eun Kim4 · Mi‑Yeon Yu5 · Kwangsoo Kim6 · Minsu Park7 · Yong Chul Kim8 · Dong Ki Kim8,9,10 · Kwon Wook Joo8,9,10 · Yon Su Kim1,8,9,10 · Hajeong Lee8,9 Received: 17 May 2020 / Accepted: 23 September 2020 © Italian Society of Nephrology 2020
Abstract Background Socioeconomic status is an important determinant for patients’ accessibility to, and prognosis of, kidney transplantation. However, the association between socioeconomic dependency and kidney transplantation accessibility or prognosis after kidney transplantation remains unclear. Methods In this nationwide cohort study, based on the claims database of South Korea, we included 12,889 kidney transplant recipients from 2007 to 2015 and stratified them according to health insurance categories that reflect socioeconomic dependency: workplace-independent (employed, N = 3257), workplace-dependent (dependent to the workplace-independent, N = 3661), community-representative (heads of the household but self-employed or unemployed, N = 2479), communitymember (N = 1618), aided-representative (heads of household receiving medical aid from the government, N = 1580), and aided-member (N = 294). The incidence of kidney transplantation was calculated to evaluate its accessibility. The risk of graft failure was assessed using the Cox regression analysis, adjusted for clinicodemographic variables, including financial status. Results End-stage kidney disease patients who were employed (workplace-independent group) had the highest incidence proportion of kidney transplantation. The dependent groups’ prognoses were worse than those of their independent counterparts [workplace-dependent versus workplace-independent, HR 1.26 (1.11–1.43) and community-dependent versus communityindependent, HR 1.46 (1.23–1.74)], although no difference was observed between the aided subgroups [aided-dependent versus aided-independent, adjusted HR 1.16 (0.90–1.50)]. Conclusion Disparities in kidney transplantation accessibility were present in South Korea according to socioeconomic dependency; these differences may have an impact on prognosis. Keywords Kidney transplantation · Disparity · Graft failure · Socioeconomic status Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00876-0) contains supplementary material, which is available to authorized users. * Hajeong Lee [email protected] 1
6
Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
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Department of Internal Medicine, Armed Forces Capital Hospital, Seoul, Republic of Korea
Department of Biostatistics, Keimyung University, Daegu, Republic of Korea
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3
Biomedical Research Institute
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