The association of socioeconomic status on kidney transplant access and outcomes: cohort studies of England and Northern Ireland
Corr, Michael Beck, Jenni Courtney, Aisling E Cardwell, Christopher Bailey, Pippa K Cockwell, Paul O'Neill, Ciaran Maxwell, Alexander P McKay, Gareth J
Corr, Michael
Beck, Jenni
Courtney, Aisling E
Cardwell, Christopher
Bailey, Pippa K
Cockwell, Paul
O'Neill, Ciaran
Maxwell, Alexander P
McKay, Gareth J
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Publication date
2025-12-12
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Abstract
Background: While socioeconomic status (SES) is an established determinant of kidney transplant access and outcomes, less is known about how these disparities vary within universal healthcare systems. This study hypothesized that, despite shared healthcare and organ allocation systems, regional differences would be observed in the magnitude and pattern of the association between SES and transplant access and outcomes between England and Northern Ireland (NI).
Methods: We conducted a retrospective cohort study using national transplant registry data from England (n = 42 220) and NI (n = 1615) from 2000 to 2020. SES was measured using national deprivation indices. Outcomes included transplant incidence, preemptive and living donor transplantation, graft survival, and patient survival. Statistical analyses included Poisson regression, Cox proportional hazards models, and concentration indices to assess equity.
Results: In England, lower SES was significantly associated with reduced transplant access (incidence rate ratio for most versus least deprived quintile, 0.71; 95% confidence interval [CI], 0.69-0.73), lower rates of preemptive and living donor transplantation, and poorer graft (hazard ratio, 1.41; 95% CI, 1.32-1.50) and patient survival (hazard ratio, 1.49; 95% CI, 1.39-1.59). These disparities persisted across ethnic groups. In contrast, NI showed no significant SES-related differences in transplant access, despite a more deprived population overall.
Conclusions: SES remains strongly associated with transplant access in England but not in NI, suggesting that regional models of healthcare delivery may mitigate or exacerbate inequities.These findings suggest a role of system design in promoting equity.
Citation
Corr M, Beck J, Courtney AE, Cardwell C, Bailey PK, Cockwell P, O'Neill C, Maxwell AP, McKay GJ. The Association of Socioeconomic Status on Kidney Transplant Access and Outcomes: Cohort Studies of England and Northern Ireland. Transplantation. 2025 Dec 12. doi: 10.1097/TP.0000000000005596. Epub ahead of print.
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