Korean J Transplant.  2023 Mar;37(1):29-40. 10.4285/kjt.22.0049.

Changes in socioeconomic status and patient outcomes in kidney transplantation recipients in South Korea

• Park S
• Park J
• Jeong J
• Jang Y
• Kim YC
• Kim DK
• Oh KH
• Joo KW
• Kim YS
• Lee H

• KMID: 2541310
• DOI: http://doi.org/10.4285/kjt.22.0049

Abstract

Background
Socioeconomic status is an important factor affecting the accessibility and prognosis of kidney transplantation. We aimed to investigate changes in kidney transplant recipients’ socioeconomic status in South Korea and whether such changes were associated with patient prognosis.
Methods
This retrospective nationwide o bservational c ohort s tudy i n S outh Korea included kidney transplant recipients between 2007 and 2016. South Korea provides a single-insurer health insurance service, and information on the socioeconomic status of the recipients is identifiable through the claims database. First, a generalized linear mixed model was used to investigate changes in recipients’ socioeconomic status as an outcome. Second, the risk of graft failure was analyzed using Cox regression as another outcome to investigate whether changes in socioeconomic status were associated with patient prognosis.
Results
Among the 15,215 kidney transplant recipients included in the study, economic levels (defined based on insurance fee percentiles) and employment rates declined within the first 2 years after transplantation. Beyond 2 years, the employment rate increased significantly, while no significant changes were observed in economic status. Patients whose economic status did not improve 3 years after kidney transplantation showed a higher risk of death than those whose status improved. When compared to those who remained employed after kidney transplantation, unemployment was associated with a significantly higher risk of death-censored graft failure.
Conclusions
The socioeconomic status of kidney transplant recipients changed dynamically after kidney transplantation, and these changes were associated with patient prognosis.

Keyword

Kidney transplant; Social class; Recipient; Prognosis; Allografts

Figure

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  Fig. 1 Study flowchart.

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  Fig. 2 Time trends of insurance fee percentiles, the proportion of employed individuals, and those who required government aid for their insurance coverage. The socioeconomic status in the year before kidney transplant to +5 years after the kidney transplantation year are presented. (A) The economic grades are identified as 21 ordinal categories covering 5 percentiles each, and the quartile groups are presented for simplification. (B) The employed individuals included those who were enrolled in the national health insurance through workplace insurance system, which indicates the recipients were employed at a regular workplace. (C) The group with insurance aid comprised those who were socioeconomically deprived, and their insurance fees and medical service costs were mostly covered by the government after approval for the qualification.

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