TY - JOUR
T1 - Sex Differences in Kidney Transplantation
T2 - Austria and the United States, 1978–2018
AU - Hödlmoser, Sebastian
AU - Gehrig, Teresa
AU - Antlanger, Marlies
AU - Kurnikowski, Amelie
AU - Lewandowski, Michał
AU - Krenn, Simon
AU - Zee, Jarcy
AU - Pecoits-Filho, Roberto
AU - Kramar, Reinhard
AU - Carrero, Juan Jesus
AU - Jager, Kitty J.
AU - Tong, Allison
AU - Port, Friedrich K.
AU - Posch, Martin
AU - Winkelmayer, Wolfgang C.
AU - Schernhammer, Eva
AU - Hecking, Manfred
AU - Ristl, Robin
N1 - Funding Information: We acknowledge support from the Austrian Science Fund (grant No. KL754-B). Publisher Copyright: Copyright © 2022 Hödlmoser, Gehrig, Antlanger, Kurnikowski, Lewandowski, Krenn, Zee, Pecoits-Filho, Kramar, Carrero, Jager, Tong, Port, Posch, Winkelmayer, Schernhammer, Hecking and Ristl.
PY - 2022/1/24
Y1 - 2022/1/24
N2 - Background: Systematic analyses about sex differences in wait-listing and kidney transplantation after dialysis initiation are scarce. We aimed at identifying sex-specific disparities along the path of kidney disease treatment, comparing two countries with distinctive health care systems, the US and Austria, over time. Methods: We analyzed subjects who initiated dialysis from 1979–2018, in observational cohort studies from the US and Austria. We used Cox regression to model male-to-female cause-specific hazard ratios (csHRs, 95% confidence intervals) for transitions along the consecutive states dialysis initiation, wait-listing, kidney transplantation and death, adjusted for age and stratified by country and decade of dialysis initiation. Results: Among 3,053,206 US and 36,608 Austrian patients starting dialysis, men had higher chances to enter the wait-list, which however decreased over time [male-to-female csHRs for wait-listing, 1978–1987: US 1.94 (1.71, 2.20), AUT 1.61 (1.20, 2.17); 2008–2018: US 1.35 (1.32, 1.38), AUT 1.11 (0.94, 1.32)]. Once wait-listed, the advantage of the men became smaller, but persisted in the US [male-to-female csHR for transplantation after wait-listing, 2008–2018: 1.08 (1.05, 1.11)]. The greatest disparity between men and women occurred in older age groups in both countries [male-to-female csHR for wait-listing after dialysis, adjusted to 75% age quantile, 2008–2018: US 1.83 (1.74, 1.92), AUT 1.48 (1.02, 2.13)]. Male-to-female csHRs for death were close to one, but higher after transplantation than after dialysis. Conclusions: We found evidence for sex disparities in both countries. Historically, men in the US and Austria had 90%, respectively, 60% higher chances of being wait-listed for kidney transplantation, although these gaps decreased over time. Efforts should be continued to render kidney transplantation equally accessible for both sexes, especially for older women.
AB - Background: Systematic analyses about sex differences in wait-listing and kidney transplantation after dialysis initiation are scarce. We aimed at identifying sex-specific disparities along the path of kidney disease treatment, comparing two countries with distinctive health care systems, the US and Austria, over time. Methods: We analyzed subjects who initiated dialysis from 1979–2018, in observational cohort studies from the US and Austria. We used Cox regression to model male-to-female cause-specific hazard ratios (csHRs, 95% confidence intervals) for transitions along the consecutive states dialysis initiation, wait-listing, kidney transplantation and death, adjusted for age and stratified by country and decade of dialysis initiation. Results: Among 3,053,206 US and 36,608 Austrian patients starting dialysis, men had higher chances to enter the wait-list, which however decreased over time [male-to-female csHRs for wait-listing, 1978–1987: US 1.94 (1.71, 2.20), AUT 1.61 (1.20, 2.17); 2008–2018: US 1.35 (1.32, 1.38), AUT 1.11 (0.94, 1.32)]. Once wait-listed, the advantage of the men became smaller, but persisted in the US [male-to-female csHR for transplantation after wait-listing, 2008–2018: 1.08 (1.05, 1.11)]. The greatest disparity between men and women occurred in older age groups in both countries [male-to-female csHR for wait-listing after dialysis, adjusted to 75% age quantile, 2008–2018: US 1.83 (1.74, 1.92), AUT 1.48 (1.02, 2.13)]. Male-to-female csHRs for death were close to one, but higher after transplantation than after dialysis. Conclusions: We found evidence for sex disparities in both countries. Historically, men in the US and Austria had 90%, respectively, 60% higher chances of being wait-listed for kidney transplantation, although these gaps decreased over time. Efforts should be continued to render kidney transplantation equally accessible for both sexes, especially for older women.
KW - ADTR
KW - USRDS
KW - chronic kidney disease
KW - dialysis
KW - gender
KW - kidney transplantation
KW - sex
UR - http://www.scopus.com/inward/record.url?scp=85124238966&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fmed.2021.800933
DO - https://doi.org/10.3389/fmed.2021.800933
M3 - Article
C2 - 35141249
SN - 2296-858X
VL - 8
JO - Frontiers in Medicine
JF - Frontiers in Medicine
M1 - 800933
ER -