Wang Jiayuan, Cho Kellie C, Tantisattamo Ekamol
American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, CA 92868, United States.
Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697, United States.
J Am Med Inform Assoc. 2024 Dec 1;31(12):2781-2788. doi: 10.1093/jamia/ocae178.
Disparity in kidney transplant access has been demonstrated by a disproportionately low rate of kidney transplantation in socioeconomically disadvantaged patients. However, the information is not from national representative populations with end-stage kidney disease (ESKD). We aim to examine whether socioeconomic disparity for kidney transplant access exists by utilizing data from the All of Us Research Program.
We analyzed data of adult ESKD patients using the All of Us Researcher Workbench. The association of socioeconomic data including types of health insurance, levels of education, and household incomes with kidney transplant access was evaluated by multivariable logistic regression analysis adjusted by baseline demographic, medical comorbidities, and behavioral information.
Among 4078 adults with ESKD, mean diagnosis age was 54 and 51.64% were male. The majority had Medicare (39.6%), were non-graduate college (75.79%), and earned $10 000-24 999 annual income (20.16%). After adjusting for potential confounders, insurance status emerged as a significant predictor of kidney transplant access. Individuals covered by Medicaid (adjusted odds ratio [AOR] 0.45; 95% confidence interval [CI], 0.35-0.58; P-value < .001) or uninsured (AOR 0.21; 95% CI, 0.12-0.37; P-value < .001) exhibited lower odds of transplantation compared to those with private insurance.
DISCUSSION/CONCLUSION: Our findings reveal the influence of insurance status and socioeconomic factors on access to kidney transplantation among ESKD patients. Addressing these disparities through expanded insurance coverage and improved healthcare access is vital for promoting equitable treatment and enhancing health outcomes in vulnerable populations.
社会经济地位不利的患者肾移植率低得不成比例，这已表明了肾移植可及性方面的差异。然而，这些信息并非来自具有终末期肾病（ESKD）的全国代表性人群。我们旨在利用“我们所有人”研究计划的数据，研究肾移植可及性方面是否存在社会经济差异。
我们使用“我们所有人”研究者工作台分析了成年ESKD患者的数据。通过多变量逻辑回归分析评估包括健康保险类型、教育水平和家庭收入在内的社会经济数据与肾移植可及性之间的关联，并对基线人口统计学、医疗合并症和行为信息进行了调整。
在4078名成年ESKD患者中，平均诊断年龄为54岁，男性占51.64%。大多数人有医疗保险（39.6%），未获得大学学位（75.79%），年收入为10000 - 24999美元（20.16%）。在调整潜在混杂因素后，保险状况成为肾移植可及性的一个重要预测因素。与有私人保险的人相比，医疗补助覆盖的个体（调整后的优势比[AOR]为0.45；95%置信区间[CI]，0.35 - 0.58；P值<0.001）或未参保个体（AOR为0.21；95%CI，0.12 - 0.37；P值<0.001）的移植几率较低。
讨论/结论：我们的研究结果揭示了保险状况和社会经济因素对ESKD患者肾移植可及性的影响。通过扩大保险覆盖范围和改善医疗可及性来解决这些差异，对于促进弱势群体的公平治疗和改善健康结果至关重要。
