WHAT IF SOCIOECONOMICS MADE NO DIFFERENCE - ACCESS TO A CADAVER KIDNEY-TRANSPLANT AS AN EXAMPLE

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.