Kihal-Talantikite Wahida, Vigneau Cécile, Deguen Séverine, Siebert Muriel, Couchoud Cécile, Bayat Sahar
EHESP School of Public Health, Sorbonne Paris Cité, Rennes, France.
CHU Pontchaillou, Service de néphrologie, Rennes, France.
PLoS One. 2016 Apr 15;11(4):e0153431. doi: 10.1371/journal.pone.0153431. eCollection 2016.
Public and scientific concerns about the social gradient of end-stage renal disease and access to renal replacement therapies are increasing. This study investigated the influence of social inequalities on the (i) access to renal transplant waiting list, (ii) access to renal transplantation and (iii) patients' survival.
All incident adult patients with end-stage renal disease who lived in Bretagne, a French region, and started dialysis during the 2004-2009 period were geocoded in census-blocks. To each census-block was assigned a level of neighborhood deprivation and a degree of urbanization. Cox proportional hazards models were used to identify factors associated with each study outcome.
Patients living in neighborhoods with low level of deprivation had more chance to be placed on the waiting list and less risk of death (HR = 1.40 95%CI: [1.1-1.7]; HR = 0.82 95%CI: [0.7-0.98]), but this association did not remain after adjustment for the patients' clinical features. The likelihood of receiving renal transplantation after being waitlisted was not associated with neighborhood deprivation in univariate and multivariate analyses.
In a mixed rural and urban French region, patients living in deprived or advantaged neighborhoods had the same chance to be placed on the waiting list and to undergo renal transplantation. They also showed the same mortality risk, when their clinical features were taken into account.
公众和科学界对终末期肾病的社会梯度以及获得肾脏替代治疗的关注日益增加。本研究调查了社会不平等对（i）进入肾脏移植等候名单、（ii）获得肾脏移植以及（iii）患者生存率的影响。
对居住在法国布列塔尼地区、在2004年至2009年期间开始透析的所有成年终末期肾病新发病例患者进行了普查街区地理编码。为每个普查街区分配了邻里贫困水平和城市化程度。采用Cox比例风险模型来确定与每个研究结果相关的因素。
生活在贫困水平较低社区的患者进入等候名单的机会更多，死亡风险更低（风险比=1.40，95%置信区间：[1.1-1.7]；风险比=0.82，95%置信区间：[0.7-0.98]），但在对患者临床特征进行调整后，这种关联不再存在。在单因素和多因素分析中，列入等候名单后接受肾脏移植的可能性与邻里贫困无关。
在法国一个城乡混合地区，生活在贫困或富裕社区的患者进入等候名单和接受肾脏移植的机会相同。当考虑到他们的临床特征时，他们的死亡风险也相同。
