Comprehensive Access and Delivery Research Evaluation (CADRE), Iowa City VAMC, Iowa City, IA.
Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA.
Transplantation. 2019 Sep;103(9):1945-1952. doi: 10.1097/TP.0000000000002624.
Although proportionally more veterans live in rural areas compared to nonveterans, the impact of rurality status on kidney transplantation (KTP) access among veterans is unknown. Our objective was to study KTP rates among veterans listed for KTP and to compare the impact of rurality status on KTP rates among veterans and nonveterans.
Retrospective cohort study of adult patients waitlisted per the United Network for Organ Sharing from January 2000 to December 2014. Patient characteristics were compared using Chi-square or t tests, as appropriate, by veteran status and patient rurality. Multivariable competing-risks Cox regression was performed.
The study sample included 3281 veterans receiving care in Veteran Health Administration transplant programs and 445 177 nonveterans. Veterans, compared to nonveterans, were older (57 versus 50 y; P < 0.001), more likely to be male (96% versus 60%; P < 0.001) or diabetic at waitlisting (51% versus 41%; P < 0.001), and less likely be an urban resident (79% versus 84%; P < 0.001). Among veterans, dialysis duration prior to registration was longer among urban compared to all other rurality types (810 ± 22.1 d versus 632 to 702 ± 41.6 to 77.6 d; P = 0.02). In multivariate competing risks models, there was no evidence that the hazard of transplant among veterans differs by residential rurality.
Among waitlisted veterans served by Veteran Health Administration transplant programs, residential rurality status does not portend longer waiting time for KTP.
尽管与非退役军人相比，退役军人中农村人口的比例更高，但农村人口身份对退役军人接受肾移植（KTP）的影响尚不清楚。我们的目的是研究接受 KTP 治疗的退役军人的 KTP 率，并比较农村人口身份对退役军人和非退役军人 KTP 率的影响。
这是一项回顾性队列研究，纳入了 2000 年 1 月至 2014 年 12 月期间根据美国器官共享网络等待 KTP 的成年患者。使用卡方检验或 t 检验比较退役军人和非退役军人的患者特征，具体取决于农村人口身份。采用多变量竞争风险 Cox 回归。
研究样本包括 3281 名在退伍军人健康管理局移植项目中接受治疗的退役军人和 445177 名非退役军人。与非退役军人相比，退役军人年龄更大（57 岁比 50 岁；P<0.001），男性（96%比 60%；P<0.001）或糖尿病（51%比 41%；P<0.001）等待 KTP 时的比例更高，城市居民（79%比 84%；P<0.001）的比例更低。在退役军人中，与其他所有农村类型相比，城市居民登记前的透析时间更长（810±22.1 d 比 632 至 702±41.6 至 77.6 d；P=0.02）。在多变量竞争风险模型中，没有证据表明退役军人的移植风险因居住农村人口身份而异。
在退伍军人健康管理局移植项目服务的等待 KTP 的退役军人中，居住农村人口身份并不预示着 KTP 的等待时间更长。
