Rurality of patient residence and access to transplantation among children with kidney failure in the United States,Pediatric Nephrology

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Rurality of patient residence and access to transplantation among children with kidney failure in the United States
Pediatric Nephrology ( IF 3 ) Pub Date : 2024-04-01 , DOI: 10.1007/s00467-023-06148-w
Gabriela Accetta-Rojas _{1,

2} , Charles E McCulloch ₁ , Adrian M Whelan ₃ , Timothy P Copeland ₃ , Barbara A Grimes ₁ , Elaine Ku _{1,

3,

4}

Affiliation

Abstract

Background

Residence in rural areas is often a barrier to health care access. To date, differences in access to kidney transplantation among children who reside in rural and micropolitan areas of the US have not been explored.

Methods

A retrospective cohort study of children < 18 years who developed kidney failure between 2000 and 2019 according to the United States Renal Data System (USRDS). We examined the association between rurality of patient residence and time to living and/or deceased donor kidney transplantation (primary outcomes) and waitlist registration (secondary outcome) using Fine–Gray models.

Results

We included 18,530 children, of whom 14,175 (76.5%) received a kidney transplant (39.8% from a living and 60.2% from a deceased donor). Residence in micropolitan (subhazard ratio (SHR) 1.16; 95% CI 1.06–1.27) and rural (SHR 1.18; 95% CI 1.06–1.3) areas was associated with better access to living donor transplantation compared with residence in metropolitan areas. There was no statistically significant association between residence in micropolitan (SHR, 0.95; 95%CI 0.88–1.03) and rural (SHR, 0.94; 95%CI 0.86–1.03) areas compared with metropolitan areas in the access of children to deceased donor transplantation. There was also no difference in the time to waitlist registration comparing micropolitan (SHR 1.04; 95%CI 0.98–1.10) and rural (SHR 1.05; 95% CI 0.98–1.13) versus metropolitan areas.

Conclusions

In children with kidney failure, residence in rural and micropolitan areas was associated with better access to living donor transplantation and similar access to deceased donor transplantation compared with residence in metropolitan areas.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

中文翻译：

美国肾衰竭儿童患者居住的农村地区和接受移植的情况

摘要

背景

居住在农村地区往往是获得医疗保健的障碍。迄今为止，尚未探讨居住在美国农村和小城市地区的儿童获得肾移植的差异。

方法

根据美国肾脏数据系统 (USRDS)，对 2000 年至 2019 年间发生肾衰竭的 18 岁以下儿童进行回顾性队列研究。我们使用 Fine-Gray 模型研究了患者居住地的农村地区与活着和/或死亡的供体肾移植时间（主要结果）和候补名单登记（次要结果）之间的关联。

结果

我们纳入了 18,530 名儿童，其中 14,175 名（76.5%）接受了肾移植（39.8% 来自活体捐赠者，60.2% 来自已故捐赠者）。与居住在大都市地区相比，居住在小城市（亚危险比（SHR）1.16；95% CI 1.06–1.27）和农村（SHR 1.18；95% CI 1.06–1.3）地区与更好地获得活体供体移植有关。与大都市地区相比，居住在小城市（SHR，0.95；95%CI 0.88–1.03）和农村（SHR，0.94；95%CI 0.86–1.03）地区的儿童接受已故捐献者移植的机会没有统计学上的显着相关性。与大都市地区相比，小城市（SHR 1.04；95% CI 0.98–1.10）和农村（SHR 1.05；95% CI 0.98–1.13）的候补登记时间也没有差异。