Socioeconomic disparities in kidney transplant access for patients with end-stage kidney disease within the All of Us Research Program.

IF 4.7 2区 医学 Q1 COMPUTER SCIENCE, INFORMATION SYSTEMS Journal of the American Medical Informatics Association Pub Date : 2024-09-02 DOI:10.1093/jamia/ocae178
Jiayuan Wang, Kellie C Cho, Ekamol Tantisattamo
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Abstract

Objectives: Disparity in kidney transplant access has been demonstrated by a disproportionately low rate of kidney transplantation in socioeconomically disadvantaged patients. However, the information is not from national representative populations with end-stage kidney disease (ESKD). We aim to examine whether socioeconomic disparity for kidney transplant access exists by utilizing data from the All of Us Research Program.

Materials and methods: We analyzed data of adult ESKD patients using the All of Us Researcher Workbench. The association of socioeconomic data including types of health insurance, levels of education, and household incomes with kidney transplant access was evaluated by multivariable logistic regression analysis adjusted by baseline demographic, medical comorbidities, and behavioral information.

Results: Among 4078 adults with ESKD, mean diagnosis age was 54 and 51.64% were male. The majority had Medicare (39.6%), were non-graduate college (75.79%), and earned $10 000-24 999 annual income (20.16%). After adjusting for potential confounders, insurance status emerged as a significant predictor of kidney transplant access. Individuals covered by Medicaid (adjusted odds ratio [AOR] 0.45; 95% confidence interval [CI], 0.35-0.58; P-value < .001) or uninsured (AOR 0.21; 95% CI, 0.12-0.37; P-value < .001) exhibited lower odds of transplantation compared to those with private insurance.

Discussion/conclusion: Our findings reveal the influence of insurance status and socioeconomic factors on access to kidney transplantation among ESKD patients. Addressing these disparities through expanded insurance coverage and improved healthcare access is vital for promoting equitable treatment and enhancing health outcomes in vulnerable populations.

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在 "我们所有人 "研究计划中,终末期肾病患者接受肾移植的社会经济差距。
目的:社会经济状况不佳的患者接受肾移植的比例过低,这证明了肾移植机会的不均等。然而,这些信息并非来自具有全国代表性的终末期肾病(ESKD)患者。我们旨在利用 "我们所有人研究计划"(All of Us Research Program)的数据,研究肾移植机会是否存在社会经济差异:我们使用 "我们所有人 "研究人员工作台分析了成年 ESKD 患者的数据。通过多变量逻辑回归分析评估了社会经济数据(包括医疗保险类型、教育水平和家庭收入)与肾移植机会的关系,并对基线人口学、医疗合并症和行为信息进行了调整:在 4078 名 ESKD 患者中,平均诊断年龄为 54 岁,51.64% 为男性。大多数人有医疗保险(39.6%),非研究生学历(75.79%),年收入在 10 000-24 999 美元之间(20.16%)。在对潜在的混杂因素进行调整后,保险状况成为肾移植机会的重要预测因素。与有私人保险的患者相比,有医疗补助的患者(调整后的几率比[AOR]为 0.45;95% 置信区间[CI]为 0.35-0.58;P 值< .001)或无保险的患者(AOR 为 0.21;95% 置信区间[CI]为 0.12-0.37;P 值< .001)接受移植的几率较低:我们的研究结果揭示了保险状况和社会经济因素对 ESKD 患者接受肾移植的影响。通过扩大保险覆盖面和改善医疗服务来解决这些差异,对于促进公平治疗和提高弱势群体的健康状况至关重要。
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来源期刊
Journal of the American Medical Informatics Association
Journal of the American Medical Informatics Association 医学-计算机:跨学科应用
CiteScore
14.50
自引率
7.80%
发文量
230
审稿时长
3-8 weeks
期刊介绍: JAMIA is AMIA''s premier peer-reviewed journal for biomedical and health informatics. Covering the full spectrum of activities in the field, JAMIA includes informatics articles in the areas of clinical care, clinical research, translational science, implementation science, imaging, education, consumer health, public health, and policy. JAMIA''s articles describe innovative informatics research and systems that help to advance biomedical science and to promote health. Case reports, perspectives and reviews also help readers stay connected with the most important informatics developments in implementation, policy and education.
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