Perpetuating Disparity: Failure of the Kidney Transplant System to Provide the Most Kidney Transplants to Communities With the Greatest Need.
Perpetuating Disparity: Failure of the Kidney Transplant System to Provide the Most Kidney Transplants to Communities With the Greatest Need.
复制标题
永久差异：肾脏移植系统失败，无法向最需要的社区提供最多的肾脏移植。
DOI：
10.1097/sla.0000000000005585
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发表时间：
2022-10-01
影响因子：
9
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中科院分区：
文献类型：
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The burden of end stage kidney disease (ESKD) and kidney transplant (KT) rates vary significantly across the US. This study aims to examine the mismatch between ESKD burden and KT rates from a perspective of spatial epidemiology. US Renal Data System data from 2015–2017 on incident ESKD and kidney transplants per 1,000 incident ESKD cases was analyzed. Clustering of ESKD burden and KT rates at the county level was determined using local Moran’s I and correlated to county health scores (CHS). Higher percentile CHS indicated worse overall community health. Significant clusters of high ESKD burden tended to coincide with clusters of low KT rates, and vice versa. The most common cluster type had high incident ESKD with low transplant rates (377 counties). Counties in these clusters had the lowest overall mean transplant rate (61.1), highest overall mean ESKD incidence (61.3), and highest mean CHS percentile (80.9%, p<0.001 vs. all other cluster types). By comparison, counties in clusters with low ESKD incidence and high transplant rates (n=359) had the highest mean transplant rate (110.6), the lowest mean ESKD incidence (28.9), and the lowest CHS (20.2%). All comparisons to high-ESKD/low-transplant clusters were significant at p<0.001. There was a significant mismatch between kidney transplant rates and ESKD burden, where areas with the greatest need had the lowest transplant rates. This pattern exacerbates pre-existing disparities, as disadvantaged high ESKD regions already suffer from worse access to care and overall community health, as evidenced by the highest CHS scores in the study. Regions in the United States with the highest rates of end stage kidney disease also have the lowest rates of kidney transplant. At the same time, these regions have the poorest overall community health outcomes. The sources of this disparity go beyond simple changes to organ allocation, and will require multifactorial population health approaches to adequately address.
