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Sex Inequality in Kidney Transplantation Rates
Douglas E. Schaubel, BMath, MSc;
Donna E. Stewart, MD, FRCPC;
Howard I. Morrison, PhD;
Deborah L. Zimmerman, MD, FRCPC;
Jill I. Cameron, MSc;
John J. Jeffery, MD, FRCPC;
Stanley S. A. Fenton, MD, FRCPI
Arch Intern Med. 2000;160:2349-2354.
Background Men in the United States undergoing renal replacement therapy are more likely than women to receive a kidney transplant. However, the ability to pay may, in part, be responsible for this finding.
Objective To compare adult male and female transplantation rates in a setting in which equal access to medical treatment is assumed.
Methods Using data from the Canadian Organ Replacement Register, the rate of first transplantations was computed for the 20,131 men and the 13,458 women aged 20 years or older who initiated renal replacement therapy between January 1, 1981, and December 31, 1996. Poisson regression analysis was used to estimate the male-female transplantation rate ratio, adjusting for age, race, province, calendar period, underlying disease leading to renal failure, and dialytic modality. Actuarial survival methods were used to compare transplantation probability for covariable-matched cohorts of men and women.
Results Men experienced 20% greater covariable-adjusted kidney transplantation rates relative to women (rate ratio, 1.20; 95% confidence interval, 1.13-1.27). The sex disparity was stronger for cadaveric transplants (rate ratio, 1.23) compared with those from living donors (rate ratio, 1.10). The 5-year probability of receiving a transplant was 47% for men and 39% for women within covariable-matched cohorts (P<.001). The sex disparity in transplantation rates increased with increasing age. The sex effect was weaker among whites and Oriental persons (Chinese, Japanese, Vietnamese, Cambodian, Laotian, Filipino, Malaysian, Indonesian, and Korean) and stronger among blacks, Asian Indians (Indian, Pakistani, and Sri Lankan), and North American Indians (aboriginal).
Conclusion Since survival probability and quality of life are superior for patients who undergo transplantation relative to those who undergo dialysis, an increased effort should be made to distribute kidneys available for transplantation more equitably by sex among patients undergoing renal replacement therapy.
From the Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario (Mr Schaubel and Dr Morrison); the Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill (Mr Schaubel); the Toronto General Hospital, University Health Network (Drs Stewart, Zimmerman, and Fenton and Ms Cameron), the Women's Health Program (Dr Stewart and Ms Cameron), the Faculty of Medicine, University of Toronto (Drs Stewart, Zimmerman, and Fenton), and the Division of Nephrology, Toronto General Hospital (Drs Zimmerman and Fenton), Toronto, Ontario; and the Section of Nephrology, Health Science Center, University of Manitoba, Winnipeg (Dr Jeffery).
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