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Disparities in Kidney Transplantation Access among Korean Patients Initiating Dialysis: A Population-Based Cohort Study Using National Health Insurance Data (2003-2013)

 Young Choi  ;  Jaeyong Shin  ;  Jung Tak Park  ;  Kyoung Hee Cho  ;  Eun-Cheol Park  ;  Tae Hyun Kim 
 American Journal of Nephrology, Vol.45(1) : 32-39, 2017 
Journal Title
 American Journal of Nephrology 
Issue Date
Adult ; Databases, Factual ; Female ; Health Services Accessibility* ; Healthcare Disparities* ; Humans ; Income* ; Kidney Failure, Chronic/therapy* ; Kidney Transplantation* ; Male ; Middle Aged ; Renal Dialysis* ; Republic of Korea ; Social Class*
End-stage renal disease ; Kidney transplantation ; Socioeconomic status
BACKGROUND: The socioeconomic status of a person has an impact on his or her access to kidney transplantation as has been reported in western countries. This study examined the association between income level and kidney transplantation among chronic kidney disease patients undergoing dialysis in South Korea. METHODS: We analyzed data from 1,792 chronic kidney disease patients undergoing dialysis and listed in the Korean National Health Insurance Claim Database (2003-2013). The likelihood of receiving the first kidney transplant over time was analyzed using competing risk proportional hazard models on time from initiating dialysis to receiving a transplant. RESULTS: Of 1,792 patients on dialysis, only 184 patients (10.3%) received kidney transplants. Patients with medical aid had the lowest kidney transplantation rate (hazard ratio 0.29, 95% CI 0.16-0.51). A lower income level was significantly associated with a low kidney transplantation rate, after adjusting for covariates, compared to patients in the high-income level group. CONCLUSIONS: Our findings indicate that in South Korea, the total number of kidney transplants is remarkably low and there exists income disparity with regard to access to kidney transplantation. Thus, we suggest that plans be implemented to encourage organ donation and increase organ transplant accessibility for all patients irrespective of their socioeconomic status.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
김태현(Kim, Tae Hyun) ORCID logo https://orcid.org/0000-0003-1053-8958
박은철(Park, Eun-Cheol) ORCID logo https://orcid.org/0000-0002-2306-5398
박정탁(Park, Jung Tak) ORCID logo https://orcid.org/0000-0002-2325-8982
신재용(Shin, Jae Yong)
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