目的:有移民背景的患者在获得医疗保健方面的差异是众所周知的。这项研究的目的是确定移民人群之间的差异是否转化为有记录的移民患者(第一代和第二代)相对于欧洲本地出生患者的肾脏移植(KT)数量的相对差异。
方法:从成立到2022年11月10日,在PubMed进行了文献检索。研究是合格的,如果:(1)用英语写的,(2)包括移民和本地出生的KT患者,(3)在欧洲理事会成员国注册的国家执行,(4)重点关注有记录的第一代和第二代移民人口[1]。系统审查,文献综述,以及有关移民的案例报告或文章,非KT,非法移民被排除在外。结果测量是每100.000居民中KT占总人口的相对百分比。通过将移民百分比除以本地出生的居民百分比,在荟萃分析中计算比值比(OR).评估偏倚风险;在第二次荟萃分析中排除了具有高偏倚风险的文章。
结果:在109篇文章中,包括5个(n=24,614)。一项意大利研究(n=24,174)的比率低于1,为0.910(95CI0.877-0.945)。其他四篇文章(n=196,n=283,n=77,n=119)的比率高于1:1.36(95CI0.980-1.87),2.04(95CI1.56-2.68),2.23(95CI1.53-3.25)和2.64(95CI1.68-4.15)。在进行荟萃分析后,OR值无显著差异:1.68(95CI1.03-2.75)。偏差校正后,这保持不变:1.78(95CI0.961-3.31)。
结论:在我们的荟萃分析中,我们没有发现欧洲移民与本地出生人群的KT相对数量存在显著差异。然而,发现移民接受先发制人肾移植的可能性较小。研究之间的较大异质性(例如不同的样本量,患者起源,研究持续时间,成人与儿童患者)是我们分析的一个缺点。然而,我们的文章是这个未研究主题的第一篇综述。作为重要的问题(例如关于种族,活体捐献率)保持不变,需要未来的研究来解决这些问题。
OBJECTIVE: Disparities in access to healthcare for patients with an immigration background are well-known. The aim of this study was to determine whether disparities among immigrant populations translate into a relative difference in the number of kidney transplants (KT) performed in documented immigrant patients (first and second generation) relative to native-born patients in Europe.
METHODS: A literature search was performed in PubMed from inception to 11-10-2022. Studies were eligible if: (1) written in English, (2) included immigrant and native-born KT patients, (3) performed in countries registered as Council of Europe members, (4) focused on documented first- and second-generation immigrant populations [1]. Systematic reviews, literature reviews, and case reports or articles about emigration, non-KT, and undocumented immigrants were excluded. The outcome measurement was a relative percentage of KTs to the total population per 100.000 residents. By dividing the immigrant percentages by the native-born resident percentages, the odds ratio (OR) was calculated in a meta-analysis. The risk of bias was assessed; articles with high risk of bias were excluded in a second meta-analysis.
RESULTS: Out of 109 articles, 5 were included (n = 24,614). One Italian study (n = 24,174) had a ratio below 1, being 0.910 (95%CI 0.877-0.945). The other four articles (n = 196, n = 283, n = 77, n = 119) had ratios above 1: 1.36 (95%CI 0.980-1.87), 2.04 (95%CI 1.56-2.68), 2.23 (95%CI 1.53-3.25) and 2.64 (95%CI 1.68-4.15). After performing a meta-analysis, the OR did not show a significant difference: 1.68 (95%CI 1.03-2.75). After bias correction, this remained unchanged: 1.78 (95%CI 0.961-3.31).
CONCLUSIONS: In our meta-analysis we did not find a significant difference in the relative number of KTs performed in immigrant versus native-born populations in Europe. However, a lesser likelihood for immigrants to receive a pre-emptive kidney transplantation was found. Large heterogeneity between studies (e.g. different sample size, patient origins, study duration, adult vs children patients) was a shortcoming to our analysis. Nevertheless, our article is the first
review in this understudied topic. As important questions (e.g. on ethnicity, living donor rate) remain, future studies are needed to address them.