What determines geographical variation in rates of acceptance onto renal replacement therapy in England ?
To determine the independent effects of need and supply factors on the known geographical variation in acceptance rates onto renal replacement therapy (RRT) in England.
Data were obtained from all renal units in England on the characteristics of all cases aged 16 years and over, resident in England, who were accepted onto RRT in 1991 and 1992.
Of these, 5715 (94.5%) had a valid postcode that could be matched to a census ward.
Multilevel modelling using Poisson regression was used.
The number of acceptances in each census ward within age bands 16-34,35-64 and 65+was the dependent variable.
Independent effects modelled were :
(1) individual factors (age, sex) ;
(2) census ward need factors - ethnicity (expressed as the percentage of the ward population that was Asian or African-Caribbean), socio-economic deprivation - and supply factors - « access » to the nearest renal unit using crowfly and roal travel time and distance, and services available to each ward expressed as number of haemodialysis stations per 100 000 catchment population of the nearest renal unit ;
(3) district health authority level effects.
Age was a major determinant of acceptance, with a 7-fold higher rate in males aged over 64 years compared with younger men.
Acceptance rates were lower in females, with a negative age-sex interaction in females aged over 64 years. (...)
Mots-clés Pascal : Royaume Uni, Age, Sexe, Ethnie, Organe, Transplantation, Rein, Géographie, Santé
Mots-clés Pascal anglais : United Kingdom, Age, Sex, Ethnic group, Organ, Transplantation, Kidney, Geography, Health
Notice produite par :
ORS Auvergne - Observatoire Régional de la Santé d'Auvergne
Code Inist : 002B30A11. Création : 14/12/1999.