Conflict of interest: None.
Recipient's unemployment restricts access to renal transplantation
Article first published online: 30 JUN 2013
© 2013 John Wiley & Sons A/S.
Volume 27, Issue 4, pages 598–606, July/August 2013
How to Cite
Recipient's unemployment restricts access to renal transplantation., , , , , , , .
- Issue published online: 7 AUG 2013
- Article first published online: 30 JUN 2013
- Manuscript Accepted: 21 MAY 2013
- departmental funds
- renal allograft;
- waiting list
Equitable distribution of a scarce resource such as kidneys for transplantation can be a challenging task for transplant centers. In this study, we evaluated the association between recipient's employment status and access to renal transplantation in patients with end-stage renal disease (ESRD). We used data from the United States Renal Data System (USRDS). The primary variable of interest was employment status at ESRD onset. Two outcomes were analyzed in Cox model: (i) being placed on the waiting list for renal transplantation or being transplanted (whichever occurred first); and (ii) first transplant in patients who were placed on the waiting list. We analyzed 429 409 patients (age of ESRD onset 64.2 ± 15.2 yr, 55.0% males, 65.1% White). Compared with patients who were unemployed, patients working full time were more likely to be placed on the waiting list/transplanted (HR 2.24, p < 0.001) and to receive a transplant once on the waiting list (HR 1.65, p < 0.001). Results indicate that recipient's employment status is strongly associated with access to renal transplantation, with unemployed and partially employed patients at a disadvantage. Adding insurance status to the model reduces the effect size, but the association still remains significant, indicating additional contribution from other factors.