Rj. Ozminkowski et al., WHAT IF SOCIOECONOMICS MADE NO DIFFERENCE - ACCESS TO A CADAVER KIDNEY-TRANSPLANT AS AN EXAMPLE, Medical care, 36(9), 1998, pp. 1398-1406
OBJECTIVES. Several studies have noted the impact of socioeconomic fac
tors on access to expensive medical care, but none of those studies co
ntrolled for self-reported health and functional status or attitudes a
bout treatment alternatives when analyses were completed. Because thes
e factors may be correlated with socioeconomic status, the failure to
control for them may have led to bias in other studies. The authors me
rged data from secondary sources with telephone survey data from a nat
ional sample of 456 end-stage renal disease patients to show how estim
ates of the effects of socioeconomic factors change when self-reported
health and functional status and attitudes about treatment are incorp
orated into statistical models. The authors also showed how kidney tra
nsplant rates would change if socioeconomic factors no longer influenc
es organ allocation decisions. METHODS. Weibull proportional hazard an
alyses were used to show relationships between socioeconomic measures
and waiting list entry and kidney transplant rates, before versus afte
r accounting for self-reported health and functional status, attitudes
about treatment, and other variables. Simulation analyses were used t
o estimate the number of waiting list spots and transplant operations
that would move from economically advantaged to disadvantaged persons
if socioeconomics no longer influenced organ allocation decisions. RES
ULTS. Incorporating information about health and functional status, at
titudes about treatment, and other factors into the hazard models ofte
n reduced the estimated impact of socioeconomic measures on the odds o
f (1) being on a waiting list for a cadaver kidney transplant and (2)
receiving a transplant. Simulations showed that 30 to 65 waiting list
spots or transplant operations per 1,000 patients would shift from eco
nomically advantaged to disadvantaged persons if socioeconomics no lon
ger influenced organ allocation decisions. CONCLUSIONS. Successful eff
orts to level the playing field would result in substantial redistribu
tions of kidney transplants from economically advantaged to disadvanta
ged persons.