UNEMPLOYMENT IN INNER-CITY RENAL-TRANSPLANT RECIPIENTS - PREDICTIVE AND SOCIODEMOGRAPHIC FACTORS

Studies of dialysis patients report unemployment rates of 60% to 75%; however, it is generally believed that following transplantation, impr ovement in well-being and removal of time constraints imposed by the d ialytic regimen afford improvement in employment status. We studied 58 stable renal transplant recipients attending an outpatient transplant clinic by questionnaire, administered anonymously. Only 25 (43%) of t he patients were currently employed. Employed and unemployed patients did not differ when compared for age, gender, race, cause of renal dis ease, type of transplant or prior dialysis, time on dialysis or time s ince transplantation, years of education, or prestige score or classif ication (''blue collar'' v ''white collar'') of prior job. In the empl oyed group, 24 (96%) patients had worked before developing kidney dise ase compared with 23 (70%) patients in the unemployed group (P < 0.05) . While on dialysis, 19 (79%) of the employed patients continued worki ng compared with 10 (30%) of the unemployed patients (P < 0.005), Majo r reasons for discontinuing work after starting dialysis for both grou ps were subjective illness (feeling too sick, 51%), followed by interf erence of the dialysis regimen with time necessary for work (32%). Onl y 15% of the previously employed patients did not work after transplan tation because of feeling too sick. By multiple logistic regression, t he strongest predictors of employment posttransplant were being more t han 1 year posttransplant (odds ratio, 2.36; 95% confidence interval, 1.01 to 5.5) and having been employed before transplantation (odds rat io, 3.79; 95% confidence interval, 1.60 to 9.02). Over half of the une mployed patients (20 [61%]) expressed interest in job training, Eighty percent to 90% of patients in both groups were insured by Medicare, w ith the second greatest number insured by Medicaid. Of the 15 unemploy ed patients insured by Medicaid, 67% reported that their decision not to work was related to fear of losing Medicaid benefits because they c ould not afford medications without it, Despite no difference in actua l type of insurance carried, 17 (51%) of the unemployed patients belie ved their health insurance coverage was inadequate compared with four (12%) of the employed patients (P = 0.005, chi-squared test), Unemploy ment remains a significant problem for our population of inner-city re nal transplant recipients. Attention to job retention or retraining du ring the early renal disease and dialysis therapy period may promote b etter rehabilitation following transplantation. However, for this popu lation, with limited employment opportunities, removal of disincentive s to work, including loss of insurance and inability to pay for medica tions, will be necessary before we can provide optimal rehabilitation for renal transplant recipients from all social strata. (C) 1997 by th e National Kidney Foundation, Inc.