Health and wealth in children and adolescents with kidney transplants (K-CAD study)

Abstract

Background: Poverty and social inequality are major barriers for achieving optimal health outcomes in children, but their impact on outcomes in children after kidney transplantation remains unclear. The K-CAD study is an Australian multicentre longitudinal cohort study that aims to describe the prevalence of economic hardship among caregivers and to determine the relationship between socioeconomic status of caregivers and self-rated health of children with chronic kidney disease (CKD). Method: Two hundred and ninety-three children aged 6-18 years with CKD [stage 1-2 (n=69), stage 3-5 (n=77), dialysis (n=35), transplant (n=112)] were recruited from four tertiary children's hospitals across Australia. Comparisons by quintile of socioeconomic status for nominal self-rated health outcomes among children with CKD were analysed using adjusted multinomial logistic regression. Results: The mean ages of the caregivers and children were 43.5 years (SD: 8.0) and 12.5 (SD:3.9), respectively. More than 50% of all households earned less than $1250AUD per week. Only 20% (n=60) of caregivers engaged in fulltime employment and 30% (n=89) had completed tertiary education. Across the cohort, carers who reported higher levels of financial difficulty were twice as likely to report that their child's health was poor than those with lower levels of financial difficulty (OR 2.01, [95% CI 1.2-3.3], p<0.01). Compared to children with pre end-stage disease, parents of children with a kidney transplant were more than twice as likely to report that their income had decreased since the diagnosis of their child's disease (OR 2.4, [95% CI 1.4-4.3]), and parents of children on dialysis were nearly five times as likely (OR 4.8, [95% CI 2.1-10.9], p<0.05). Socioeconomic status did not have a significant effect on access to pre-emptive transplantation or graft outcomes. Conclusion: Socioeconomic status of caregivers appears to have a profound impact on the self-rated health in children with CKD. Families of children with end stage renal disease experience more financial hardship compared to those with less severe disease. Longitudinal follow-up will help delineate the cause of socioeconomic disadvantage in these children and the long-term effects on disease progression and wellbeing outcomes.L6130047562016-11-08 <br />