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Associations between deprivation, geographic location, and access to pediatric kidney care in the United Kingdom

Research output: Contribution to journalArticlepeer-review

Lucy A. Plumb, Manish D. Sinha, Anna Casula, Carol D. Inward, Stephen D. Marks, Fergus J. Caskey, Yoav Ben-Shlomo

Original languageEnglish
Pages (from-to)194-203
Number of pages10
JournalClinical Journal Of The American Society Of Nephrology
Volume16
Issue number2
DOIs
Published2021

Bibliographical note

Funding Information: L. Plumb is supported by the NIHR Research Trainees Coordinating Centre (DRF-2016-09-055). This publication presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Findings fromthis part of this study were presented in abstract form at the American Society of Nephrology Kidney Week 2019. Publisher Copyright: © 2021 by the American Society of Nephrology. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Background and objectives Pre-emptive kidney transplantation is advocated as best practice for children with kidney failure who are transplant eligible; however, it is limited by late presentation. We aimed to determine whether socioeconomic deprivation and/or geographic location (distance to the center and rural/urban residence) are associated with late presentation, and to what degree these factors could explain differences in accessing pre-emptive transplantation. Design, setting,participants,& measurements Acohort studyusing prospectively collected United Kingdom Renal Registry and National Health Service Blood and Transplant data from January 1, 1996 to December 31, 2016 was performed. We included children aged >3 months to ≤16 years at the start of KRT. Multivariable logistic regression models were used to determine associations between the above exposures and our outcomes: late presentation (defined as starting KRT within 90 days of first nephrology review) and pre-emptive transplantation, with a priori specified covariates. Results Analysis was performed on 2160 children(41%females),with amedianage of 3.8years (interquartile range, 0.2-9.9 years) at first nephrology review. Excluding missing data, 478 were late presenters (24%); 565 (26%) underwent pre-emptive transplantation, none of whom were late presenting. No association was seen between distance or socioeconomic deprivation with late presentation, in crude or adjusted analyses. Excluding late presenters,greater area affluence was associated with higher odds of pre-emptive transplantation, (odds ratio, 1.20 per quintile greater affluence; 95%confidence interval, 1.10 to 1.31), with children of South Asian (odds ratio, 0.52; 95%confidence interval, 0.36 to 0.76) or Black ethnicity (odds ratio, 0.31; 95%confidence interval, 0.12 to 0.80) less likely to receive one. A longer distance to the center was associated with pre-emptive transplantation on crude analyses; however, this relationship was attenuated (odds ratio, 1.02 per 10 km; 95% confidence interval, 0.99 to 1.05) in the multivariable model. Conclusions Socioeconomic deprivation or geographic location are not associated with late presentation in children in the United Kingdom. Geographic location was not independently associated with pre-emptive transplantation; however, children frommore affluent areas were more likely to receive a pre-emptive transplant.

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