Barriers to Evaluation and Wait Listing for Kidney Transplantation
Barriers to Evaluation and Wait Listing for Kidney Transplantation
复制标题
DOI：
10.2215/cjn.08620910
复制
发表时间：
2011-07-01
影响因子：
9.8
通讯作者：
Meier-Kriesche, Herwig-Ulf
中科院分区：
文献类型：
--
作者：
Schold, Jesse D.;Gregg, Jon A.;Meier-Kriesche, Herwig-Ulf
背景和目的许多因素已被证明与终末期肾病患者在等待名单上的位置和接受肾移植有关。我们的研究的目的是评估因素和评估的相互作用，在一个大的队列的转介患者从一个单一的institution.Design，设置，参与者，和测量移植进展相关的患者特征我们检查了3029连续成人患者从2003年至2008年移植。单变量和多变量logistic模型被用来评估与移植进展相关的因素，包括收到的评估，等待名单的位置，并收到一个transplant.Results的56%，27%，和17%的转诊患者进行了评估，被放置在等待名单上，并在研究期间分别接受移植。年龄较大、收入中位数较低和非商业保险与接受移植的可能性降低有关。非裔美国人（57%）和白人（56%）之间的评价比例没有差异。随着收入和保险的进一步调整，按种族划分的等候名单安置的差异被削弱。非洲裔美国人和高加索人与商业insurance.Conclusions种族/民族，年龄，保险状况和收入的可能性之间的等待名单上的位置没有差异，与患者进展移植的主导因素。种族/民族的差异可能在很大程度上是由保险状况和收入解释的，这可能表明，尽管有医疗保险权利，但可变的保险覆盖范围加剧了ESRD人群接受移植的差异。Clin J Am Soc Nephrol 6：1760-1767，2011. doi：10.2215/CJN.08620910
Background and objectives Many factors have been shown to be associated with ESRD patient placement on the waiting list and receipt of kidney transplantation. Our study aim was to evaluate factors and assess the interplay of patient characteristics associated with progression to transplantation in a large cohort of referred patients from a single institution.Design, setting, participants, & measurements We examined 3029 consecutive adult patients referred for transplantation from 2003 to 2008. Uni- and multivariable logistic models were used to assess factors associated with progress to transplantation including receipt of evaluations, waiting list placement, and receipt of a transplant.Results A total of 56%, 27%, and 17% of referred patients were evaluated, were placed on the waiting list, and received a transplant over the study period, respectively. Older age, lower median income, and noncommercial insurance were associated with decreased likelihood to ascend steps to receive a transplant. There was no difference in the proportion of evaluations between African Americans (57%) and Caucasians (56%). Age-adjusted differences in waiting list placement by race were attenuated with further adjustment for income and insurance. There was no difference in the likelihood of waiting list placement between African Americans and Caucasians with commercial insurance.Conclusions Race/ethnicity, age, insurance status, and income are predominant factors associated with patient progress to transplantation. Disparities by race/ethnicity may be largely explained by insurance status and income, potentially suggesting that variable insurance coverage exacerbates disparities in access to transplantation in the ESRD population, despite Medicare entitlement. Clin J Am Soc Nephrol 6: 1760-1767, 2011. doi: 10.2215/CJN.08620910