PDF(Pubmed)
Abstract：
BACKGROUND: Residence in rural areas is often a barrier to health care access. To date, differences in access to kidney transplantation among children who reside in rural and micropolitan areas of the US have not been explored.
METHODS: A retrospective cohort study of children < 18 years who developed kidney failure between 2000 and 2019 according to the United States Renal Data System (USRDS). We examined the association between rurality of patient residence and time to living and/or deceased donor kidney transplantation (primary outcomes) and waitlist registration (secondary outcome) using Fine-Gray models.
RESULTS: We included 18,530 children, of whom 14,175 (76.5%) received a kidney transplant (39.8% from a living and 60.2% from a deceased donor). Residence in micropolitan (subhazard ratio (SHR) 1.16; 95% CI 1.06-1.27) and rural (SHR 1.18; 95% CI 1.06-1.3) areas was associated with better access to living donor transplantation compared with residence in metropolitan areas. There was no statistically significant association between residence in micropolitan (SHR, 0.95; 95%CI 0.88-1.03) and rural (SHR, 0.94; 95%CI 0.86-1.03) areas compared with metropolitan areas in the access of children to deceased donor transplantation. There was also no difference in the time to waitlist registration comparing micropolitan (SHR 1.04; 95%CI 0.98-1.10) and rural (SHR 1.05; 95% CI 0.98-1.13) versus metropolitan areas.
CONCLUSIONS: In children with kidney failure, residence in rural and micropolitan areas was associated with better access to living donor transplantation and similar access to deceased donor transplantation compared with residence in metropolitan areas.
METHODS: A retrospective cohort study of children < 18 years who developed kidney failure between 2000 and 2019 according to the United States Renal Data System (USRDS). We examined the association between rurality of patient residence and time to living and/or deceased donor kidney transplantation (primary outcomes) and waitlist registration (secondary outcome) using Fine-Gray models.
RESULTS: We included 18,530 children, of whom 14,175 (76.5%) received a kidney transplant (39.8% from a living and 60.2% from a deceased donor). Residence in micropolitan (subhazard ratio (SHR) 1.16; 95% CI 1.06-1.27) and rural (SHR 1.18; 95% CI 1.06-1.3) areas was associated with better access to living donor transplantation compared with residence in metropolitan areas. There was no statistically significant association between residence in micropolitan (SHR, 0.95; 95%CI 0.88-1.03) and rural (SHR, 0.94; 95%CI 0.86-1.03) areas compared with metropolitan areas in the access of children to deceased donor transplantation. There was also no difference in the time to waitlist registration comparing micropolitan (SHR 1.04; 95%CI 0.98-1.10) and rural (SHR 1.05; 95% CI 0.98-1.13) versus metropolitan areas.
CONCLUSIONS: In children with kidney failure, residence in rural and micropolitan areas was associated with better access to living donor transplantation and similar access to deceased donor transplantation compared with residence in metropolitan areas.
摘要：
背景：居住在农村地区通常是获得医疗保健的障碍。迄今为止,居住在美国农村和小城市地区的儿童在接受肾脏移植方面的差异尚未被研究.
方法：根据美国肾脏数据系统（USRDS），对2000年至2019年期间发生肾衰竭的18岁以下儿童进行的回顾性队列研究。我们使用Fine-Gray模型检查了患者居住的频率与存活和/或死亡供体肾移植时间（主要结果）和候补登记（次要结果）之间的关联。
结果：我们包括18,530名儿童，其中14,175人(76.5%)接受了肾脏移植(39.8%来自活着的人，60.2%来自已故的捐赠者)。与居住在大都市地区相比，居住在小城市地区（亚危险比（SHR）1.16；95％CI1.06-1.27）和农村地区（SHR1.18；95％CI1.06-1.3）与更好地获得活体供体移植相关。居住在微型城市(SHR，0.95；95CI0.88-1.03）和农村（SHR，0.94；95CI0.86-1.03）在儿童获得死亡供体移植方面与大都市地区相比。与大都市地区（SHR1.04;95CI0.98-1.10）和农村地区（SHR1.05;95％CI0.98-1.13）相比，候补登记时间也没有差异。
结论：在患有肾衰竭的儿童中，与居住在大都市地区相比，居住在农村和小城市地区与更容易获得活体供体移植和死亡供体移植相似。更高分辨率版本的图形摘要可作为补充信息。
方法：根据美国肾脏数据系统（USRDS），对2000年至2019年期间发生肾衰竭的18岁以下儿童进行的回顾性队列研究。我们使用Fine-Gray模型检查了患者居住的频率与存活和/或死亡供体肾移植时间（主要结果）和候补登记（次要结果）之间的关联。
结果：我们包括18,530名儿童，其中14,175人(76.5%)接受了肾脏移植(39.8%来自活着的人，60.2%来自已故的捐赠者)。与居住在大都市地区相比，居住在小城市地区（亚危险比（SHR）1.16；95％CI1.06-1.27）和农村地区（SHR1.18；95％CI1.06-1.3）与更好地获得活体供体移植相关。居住在微型城市(SHR，0.95；95CI0.88-1.03）和农村（SHR，0.94；95CI0.86-1.03）在儿童获得死亡供体移植方面与大都市地区相比。与大都市地区（SHR1.04;95CI0.98-1.10）和农村地区（SHR1.05;95％CI0.98-1.13）相比，候补登记时间也没有差异。
结论：在患有肾衰竭的儿童中，与居住在大都市地区相比，居住在农村和小城市地区与更容易获得活体供体移植和死亡供体移植相似。更高分辨率版本的图形摘要可作为补充信息。
