Disparities in Kidney Transplantation Access among Korean Patients Initiating Dialysis: A Population-Based Cohort Study Using National Health Insurance Data (2003-2013)

Abstract

Background: The socioeconomic status of a person has an impact on his or her access to kidney transplantation as has been reported in western countries. This study examined the association between income level and kidney transplantation among chronic kidney disease patients undergoing dialysis in South Korea. Methods: We analyzed data from 1,792 chronic kidney disease patients undergoing dialysis and listed in the Korean National Health Insurance Claim Database (2003-2013). The likelihood of receiving the first kidney transplant over time was analyzed using competing risk proportional hazard models on time from initiating dialysis to receiving a transplant. Results: Of 1,792 patients on dialysis, only 184 patients (10.3%) received kidney transplants. Patients with medical aid had the lowest kidney transplantation rate (hazard ratio 0.29, 95% CI 0.16-0.51). A lower income level was significantly associated with a low kidney transplantation rate, after adjusting for covariates, compared to patients in the high-income level group. Conclusions: Our findings indicate that in South Korea, the total number of kidney transplants is remarkably low and there exists income disparity with regard to access to kidney transplantation. Thus, we suggest that plans be implemented to encourage organ donation and increase organ transplant accessibility for all patients irrespective of their socioeconomic status.