Geographic Variation in End-Stage Renal Disease Incidence and Access to Deceased Donor Kidney Transplantation
Geographic Variation in End-Stage Renal Disease Incidence and Access to Deceased Donor Kidney Transplantation
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DOI：
10.1111/j.1600-6143.2010.03043.x
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发表时间：
2010-01-01
影响因子：
8.8
通讯作者：
Wolfe, R. A.
中科院分区：
文献类型：
--
作者：
Mathur, A. K.;Ashby, V. B.;Wolfe, R. A.
以终末期肾病（ESRD）发病率衡量的肾移植需求对移植获得的影响尚不清楚。使用来自美国人口普查局，医疗保险和医疗补助服务中心（CMS）和器官采购和移植网络/移植接受者科学登记处（OPTN/SRTR）的数据，从2000年到2008年，我们进行了捐赠服务区（DSA）和患者水平的回归分析，以评估ESRD发病率对肾脏等待名单和死亡供体肾移植的影响。在DSA中，ESRD发病率随着ESRD高发病率种族组（非裔美国人和土著美国人）密度的增加而增加。在高ESRD发病率的DSA中，等待名单和移植率相对较低，但在患者水平上，等待名单的比率并没有受到ESRD发病率的显著影响。与低ESRD区域相比，高ESRD区域与所有ESRD患者中较低的调整后移植率相关（RR 0.68，95% CI 0.66-0.70）。生活在中度和高度ESRD地区的患者与生活在低度ESRD地区的患者相比，等待名单中的移植率较低（中度：RR 0.68，95%CI 0.66-0.69;高度：RR 0.63，95%CI 0.61-0.65）。获得肾移植的地理差异部分是由当地ESRD发病率介导的，这对分配政策的制定有影响。
The effect of demand for kidney transplantation, measured by end-stage renal disease (ESRD) incidence, on access to transplantation is unknown. Using data from the U.S. Census Bureau, Centers for Medicare & Medicaid Services (CMS) and the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR) from 2000 to 2008, we performed donation service area (DSA) and patient-level regression analyses to assess the effect of ESRD incidence on access to the kidney waiting list and deceased donor kidney transplantation. In DSAs, ESRD incidence increased with greater density of high ESRD incidence racial groups (African Americans and Native Americans). Wait-list and transplant rates were relatively lower in high ESRD incidence DSAs, but wait-list rates were not drastically affected by ESRD incidence at the patient level. Compared to low ESRD areas, high ESRD areas were associated with lower adjusted transplant rates among all ESRD patients (RR 0.68, 95% CI 0.66-0.70). Patients living in medium and high ESRD areas had lower transplant rates from the waiting list compared to those in low ESRD areas (medium: RR 0.68,95% CI 0.66-0.69; high: RR 0.63, 95% CI 0.61-0.65). Geographic variation in access to kidney transplant is in part mediated by local ESRD incidence, which has implications for allocation policy development.