Centre Universitaire des Maladies Rénales, Centre Hospitalier Universitaire de Caen, 14033, Caen Cedex 09, France; U1086 INSERM, Centre de Lutte Contre le Cancer François Baclesse, BP 45026, 14076, Caen Cedex 05, France; Université Caen Normandie - UFR de médecine (Medical School), 2 Rue des Rochambelles, 14032, Caen Cedex 5, France.
U1086 INSERM, Centre de Lutte Contre le Cancer François Baclesse, BP 45026, 14076, Caen Cedex 05, France.
J Clin Epidemiol. 2023 May;157:92-101. doi: 10.1016/j.jclinepi.2023.03.005. Epub 2023 Mar 10.
We assessed the direct and indirect effect of social deprivation mediated by modifiable markers of nephrological follow-up on registration on the renal transplantation waiting-list.
From the Renal Epidemiology and Information Network, we included French incident dialysis patients eligible for a registration evaluation between January 2017 and June 2018. Mediation analyses were conducted to assess effects of social deprivation estimated by quintile 5 (Q5) of the European Deprivation Index on registration defined as wait-listing at dialysis start or within the first 6 months.
Among the 11,655 included patients, 2,410 were registered. The Q5 had a direct effect on registration (odds ratio [OR]: 0.82 [0.80-0.84]) and an indirect effect mediated by emergency start dialysis (OR: 0.97 [0.97-0.98]), hemoglobin <11 g/dL and/or lack of erythropoietin (OR 0.96 [0.96-0.96]) and albumin <30 g/L (OR: 0.98 [0.98-0.99]).
Social deprivation was directly associated with a lower registration on the renal transplantation waiting-list but its effect was also mediated by markers of nephrological care, suggesting that improving the follow-up of the most deprived patients should help to reduce disparities in access to transplantation.
我们评估了可改变的肾脏随访指标介导的社会剥夺对登记进入肾脏移植等候名单的直接和间接影响。
我们从肾脏流行病学和信息网络中纳入了 2017 年 1 月至 2018 年 6 月期间符合登记评估条件的法国新进入透析的患者。进行中介分析以评估欧洲剥夺指数五分位数 5（Q5）估计的社会剥夺对登记的影响，登记定义为透析开始时或在最初 6 个月内列入等候名单。
在纳入的 11655 名患者中，有 2410 名患者进行了登记。Q5 对登记有直接影响（比值比[OR]：0.82[0.80-0.84]），并且通过紧急开始透析（OR：0.97[0.97-0.98]）、血红蛋白<11g/dL 和/或缺乏促红细胞生成素以及白蛋白<30g/L（OR：0.96[0.96-0.96]）的间接影响。
社会剥夺与肾脏移植等候名单上的登记率较低直接相关，但它的影响也与肾脏护理的标志物有关，这表明改善最贫困患者的随访应该有助于减少移植机会的差异。
