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Swift SL, Leyva Y, Wang S, Chang CCH, Dew MA, Shapiro R, Unruh M, Kendall K, Croswell E, Peipert JD, Myaskovsky L. Are cultural or psychosocial factors associated with patient-reported outcomes at the conclusion of kidney transplant evaluation? Clin Transplant 2022; 36:e14796. [PMID: 35988025 PMCID: PMC9772103 DOI: 10.1111/ctr.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Kidney transplant evaluation (KTE) is a period marked by many stressors for patients, which may lead to poorer patient-reported outcomes (PROs). Research on the association of cultural and psychosocial factors with PROs during KTE is lacking, even though cultural and psychosocial variables may mitigate the relationship between acceptance status and PROs. METHODS Using a prospective cohort study of 955 adults referred for KTE, we examined whether cultural factors and psychosocial characteristics, assessed at the initiation of KTE, are associated with PROs at KTE completion, controlling for demographics and medical factors. Also, we analyzed whether these factors moderate the relationship between transplant acceptance status and PROs. RESULTS In multivariable regression models, a stronger sense of mastery was associated with higher physical and mental QOL. A stronger sense of self-esteem was associated with higher kidney-specific QOL. Depression was associated with a lower mental QOL, but only in those who were accepted for transplant. Having low levels of external locus of control was associated with better mental QOL in those who were not accepted for transplant. Higher anxiety was associated with poorer kidney-specific QOL among those who were not accepted for KT, but trust in physician was only associated with greater satisfaction in transplant clinic service for those who were accepted for KT. CONCLUSIONS Targeting interventions to increase patient mastery and external locus of control, and reduce depression and anxiety in patients undergoing kidney transplant evaluation may be useful approaches to improve their experience during this stressful period.
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Affiliation(s)
- Samuel L. Swift
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center
- SS now at New Mexico Department of Health, Epidemiology
| | - Yuri Leyva
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center
| | - Shu Wang
- Department of Biostatistics, University of Florida
| | - Chung-Chou H. Chang
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health
- Department of Medicine, University of Pittsburgh, School of Medicine
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, School of Medicine
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine
| | - Mark Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine
| | | | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, School of Medicine
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
- Northwestern University Transplant Outcomes Research Collaboration (NUTORC), Feinberg School of Medicine, Northwestern University
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center
- Department of Internal Medicine, University of New Mexico, School of Medicine
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Park HC, Kwon YE, Choi HY, Oh HJ, Chang TI, Kang EW, Park KS, Yang KH, Won EM, Shin JH, Ryu DR, Lee YK. Health Insurance Status Is Related to Risk of Mortality and Hospitalization in Korean Maintenance Hemodialysis Patients: A Longitudinal Cohort Study. Am J Nephrol 2021; 51:975-981. [PMID: 33440390 DOI: 10.1159/000512855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND There has been an increasing incidence of hemodialysis (HD) due to old age and comorbid condition such as diabetes. In general, socioeconomic status (SES) is known as one of the most important risk factors for patient mortality and morbidity. Whether low SES is associated with poorer outcome in HD patients is controversial. This study was performed to evaluate the association of health insurance status as a proxy indicator for SES upon mortality and hospitalization in maintenance HD patients. METHODS We used HD-quality assessment data from the year of 2015 for collecting demographic and clinical data. The subjects were classified into Medical Aid (MA) recipients (low SES) and National Health Insurance (NHI) beneficiary (high SES). We analyzed mortality and hospitalization risk based on health insurance status using Cox proportional hazard model. A total of 35,454 adult HD patients ≥18 years old who received HD treatment more than twice weekly were included in the analysis. RESULTS The ratio between MA recipient and NHI beneficiary was 76.7 versus 23.3%. The MA recipient group demonstrated younger age and lower proportion of female, diabetes, hypertension, and cerebrovascular accidents compared to the NHI beneficiary group. After adjusting for age, gender, comorbidity, and laboratory parameters, the MA recipient group showed a significantly higher mortality risk compared to the NHI beneficiary group (hazard ratio 1.073 [1.009-1.14], p = 0.025). The MA recipient group was also an independent risk factor for hospitalization after adjusting for age, gender, comorbidities, and laboratory parameters (hazard ratio 1.142 [1.108-1.178], p < 0.001). CONCLUSION Low SES as measured by health insurance status was associated with an increased risk of patient mortality and hospitalization in Korean maintenance HD patients.
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Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- Kidney Research Institute, Hallym University, Seoul, Republic of Korea
| | - Young-Eun Kwon
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | | | - Hyung Jung Oh
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Republic of Korea
| | - Ea Wha Kang
- Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Republic of Korea
| | - Kyoung Sook Park
- Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Republic of Korea
| | - Ki Hwa Yang
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Eun Mi Won
- Division of Chronic Disease Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Ji Hyeon Shin
- Division of Quality Assessment Management, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea,
- Kidney Research Institute, Hallym University, Seoul, Republic of Korea,
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