Renal replacement therapy: can we separate the effects of social deprivation and ethnicity?

Britain's current ethnic mix is largely a consequence of legislation introduced following the Second World War to allow people from the British Empire and Commonwealth unhindered access to enter Britain to help revive the economy. British minority ethnic populations tend to live in more socially deprived areas, making differentiation between the effects of social deprivation and ethnicity difficult to distinguish. Free-at-the-point-of-use health care should minimize finance-related difficulty accessing treatment, and issues of geographical access to treatment will certainly differ from those of larger, more sparsely populated countries. To examine this, the UK Renal Registry has adopted an approach of studying social deprivation separately in the white-only population before studying the effect of ethnicity and social deprivation in the general population. Using this approach, rates of renal replacement therapy have been shown to be higher in individuals from socially deprived areas and, to varying extents, in those from ethnic minority groups. Attainment of standards on RRT, however, tended not to differ. Survival on RRT is lower for individuals from socially deprived areas but higher for South Asian and black patients. Inequalities have been identified in access to transplantation, with reduced access to the transplant waiting list for socially deprived patients and reduced access to transplantation, once on the waiting list, for ethnic minority patients. The reasons for these inequalities, including any contribution from underlying inequities, are the subject of ongoing research.