Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis
Background. Social inequalities in health lead to an increased risk of chronic kidney disease and less access to renal transplantation. The objective of this study was to assess the association between social deprivation estimated by the fifth quintile of the European Deprivation Index (EDI) and pre...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2021-10-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001203 |
| _version_ | 1797976879776399360 |
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| author | Eve Calvar, MBBS Ludivine Launay, MS Annabel Boyer, MD Guy Launoy, MD, PhD Thierry Lobbedez, MD Valérie Châtelet, MD, PhD |
| author_facet | Eve Calvar, MBBS Ludivine Launay, MS Annabel Boyer, MD Guy Launoy, MD, PhD Thierry Lobbedez, MD Valérie Châtelet, MD, PhD |
| author_sort | Eve Calvar, MBBS |
| collection | DOAJ |
| description | Background. Social inequalities in health lead to an increased risk of chronic kidney disease and less access to renal transplantation. The objective of this study was to assess the association between social deprivation estimated by the fifth quintile of the European Deprivation Index (EDI) and preemptive kidney transplantation (PKT) and to explore the potential mediators of this association.
Methods. This retrospective observational multicenter study included 8701 patients who received their first renal transplant in France between 2010 and 2014. Mediation analyses were performed to assess the direct and indirect effects of the EDI on PKT.
Results. Among the 8701 transplant recipients, 32.4% belonged to the most deprived quintile of the EDI (quintile 5) and 16% received a PKT (performed either with a deceased- or living-donor). There was a significant association between quintile 5 of the EDI and PKT (total effect: odds ratio [OR]: 0.64 [95% confidence interval (CI): 0.55-0.73]). Living-donor kidney transplantation was the main mediator of this association (natural indirect effect: OR: 0.92 [0.89–0.95]). To a lesser extent, positive cytomegalovirus and hepatitis C serologies and blood group B were also mediators (respective natural indirect effects: OR: 0.98 [95% CI: 0.95-1.00], OR: 0.99 [95% CI: 0.99-1.00], and OR: 0.99 [95% CI: 0.98-1.00], P < 0.05).
Conclusions. Our study suggests that social deprivation is associated with a decreased proportion of PKT. This association might be mitigated by promoting living-donor transplantation. |
| first_indexed | 2024-04-11T04:58:01Z |
| format | Article |
| id | doaj.art-c75aec0cfeb048cba1deede310062678 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-04-11T04:58:01Z |
| publishDate | 2021-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-c75aec0cfeb048cba1deede3100626782022-12-26T06:07:32ZengWolters KluwerTransplantation Direct2373-87312021-10-01710e75010.1097/TXD.0000000000001203202110000-00005Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation AnalysisEve Calvar, MBBS0Ludivine Launay, MS1Annabel Boyer, MD2Guy Launoy, MD, PhD3Thierry Lobbedez, MD4Valérie Châtelet, MD, PhD51 Centre Universitaire des Maladies Rénales, Centre Hospitalier Universitaire de Caen, France.4 U1086 Inserm, ANTICIPE, Centre de Lutte Contre le Cancer François Baclesse, Caen, France.1 Centre Universitaire des Maladies Rénales, Centre Hospitalier Universitaire de Caen, France.5 RDPLF, Pontoise, France.1 Centre Universitaire des Maladies Rénales, Centre Hospitalier Universitaire de Caen, France.1 Centre Universitaire des Maladies Rénales, Centre Hospitalier Universitaire de Caen, France.Background. Social inequalities in health lead to an increased risk of chronic kidney disease and less access to renal transplantation. The objective of this study was to assess the association between social deprivation estimated by the fifth quintile of the European Deprivation Index (EDI) and preemptive kidney transplantation (PKT) and to explore the potential mediators of this association. Methods. This retrospective observational multicenter study included 8701 patients who received their first renal transplant in France between 2010 and 2014. Mediation analyses were performed to assess the direct and indirect effects of the EDI on PKT. Results. Among the 8701 transplant recipients, 32.4% belonged to the most deprived quintile of the EDI (quintile 5) and 16% received a PKT (performed either with a deceased- or living-donor). There was a significant association between quintile 5 of the EDI and PKT (total effect: odds ratio [OR]: 0.64 [95% confidence interval (CI): 0.55-0.73]). Living-donor kidney transplantation was the main mediator of this association (natural indirect effect: OR: 0.92 [0.89–0.95]). To a lesser extent, positive cytomegalovirus and hepatitis C serologies and blood group B were also mediators (respective natural indirect effects: OR: 0.98 [95% CI: 0.95-1.00], OR: 0.99 [95% CI: 0.99-1.00], and OR: 0.99 [95% CI: 0.98-1.00], P < 0.05). Conclusions. Our study suggests that social deprivation is associated with a decreased proportion of PKT. This association might be mitigated by promoting living-donor transplantation.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001203 |
| spellingShingle | Eve Calvar, MBBS Ludivine Launay, MS Annabel Boyer, MD Guy Launoy, MD, PhD Thierry Lobbedez, MD Valérie Châtelet, MD, PhD Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis Transplantation Direct |
| title | Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis |
| title_full | Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis |
| title_fullStr | Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis |
| title_full_unstemmed | Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis |
| title_short | Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis |
| title_sort | effects of social deprivation on the proportion of preemptive kidney transplantation a mediation analysis |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001203 |
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