||El-Dassouki, N., Belenko, D., Macanovic, S., Li, V., Afzal, A., Breitner, D., Ford, H., Novak, M., Mucsi, I
Inequitable access to living donor kidney transplantation (LDKT) results in inferior clinical outcomes for patients who may be unable to access LDKT due to various barriers. Patients with lower socioeconomic status (SES) have reduced access to LDKT in the US and other countries. The association between household and neighbourhood level socioeconomic factors and access to LDKT has not been well studied in Canada. Here we analyze the association between SES and having a potential living kidney donor (pLKD) identified, a potential marker of access to LDKT.
A cross-sectional, convenience sample of adult patients with end stage kidney disease from dialysis units in Toronto completed study questionnaires using an electronic data capture system. Patients indicated if they had a pLKD identified (outcome). SES (exposure) was assessed by patient-reported information on neighbourhood safety, car ownership, and how long their family could maintain their current situation if their income was lost. Above SES variables along with income, education, employment, and ownership of a washer/dryer were summed to create a composite SES score.
A total of 755 participants were recruited (61% male, mean[SD] age: 57 years); 48% were White, 22% were Asian, 27% were Black; 39% had type II diabetes, and 38% were on dialysis for >3 years. After adjusting for demographic variables, comorbidity, ethnicity, and immigrant status in a multivariable logistic regression, higher neighbourhood safety (OR=1.9, CI=1.1-3.3, p=0.02), car ownership (OR=2.9, CI=1.9-4.6, p<0.001), and better overall SES (OR=4.0, CI=1.6-10.1, p=0.008) were significantly associated with having a pLKD.
In our analysis, higher neighbourhood safety, car ownership, and overall SES were associated with increased odds of having a pLKD identified, indicating the significant role of individual, household and neighbourhood-level socioeconomic factors on access to LDKT. Future work should be aimed at interventions to reduce socioeconomic disparities in access to LDKT.