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. 2019 Sep 10;322(10):957–973. doi: 10.1001/jama.2019.12803

Table 2. Patient Characteristics and Crude Hierarchical Cox Proportional Hazard Ratios (HRs) Among Patients Who Were Placed on the Deceased Donor Waiting List, Received a Living Donor Kidney Transplant, or Received a Deceased Donor Kidney Transplant During Follow-up, 2000-2016.

Characteristicsa Censored Date
(n = 1 341 386)b
Placement on the Deceased Donor
Waiting List
(n = 121 680) (8.2%)
Receipt of a Living Donor
Kidney Transplant
(n = 23 762) (1.6%)
Receipt of a Deceased Donor
Kidney Transplant
(n = 49 290) (3.3%)
No. (%) No. (%) HR (95% CI)c No. (%) HR (95% CI)d No. (%) HR (95% CI)e
Dialysis Facility Ownershipf
Nonprofit
Small chains (n = 109 030) 94 601 (86.8) 12 942 (11.9) 1 [Reference] 2694 (2.5) 1 [Reference] 5337 (4.9) 1 [Reference]
Independent facilities (n = 78 287) 53 992 (69.0) 23 324 (29.8) 2.74 (2.68-2.80) 3914 (5.0) 1.90 (1.81-2.00) 8899 (11.4) 2.07 (2.00-2.14)
For-profit
Large chain 1 (n = 483 988) 444 858 (91.2) 34 027 (7.0) 0.58 (0.57-0.59) 6719 (1.4) 0.57 (0.54-0.60) 14 006 (2.9) 0.60 (0.58-0.62)
Large chain 2 (n = 482 689) 447 759 (92.8) 29 812 (6.2) 0.52 (0.51-0.53) 6403 (1.3) 0.55 (0.53-0.58) 12 652 (2.6) 0.56 (0.54-0.58)
Small chains (n = 225 890) 209 161 (92.6) 14 815 (6.6) 0.55 (0.54-0.57) 2674 (1.2) 0.49 (0.47-0.52) 5926 (2.6) 0.56 (0.54-0.58)
Independent facilities (n = 98 680) 91 105 (92.2) 6760 (6.9) 0.59 (0.57-0.61) 1358 (1.4) 0.59 (0.55-0.62) 2470 (2.5) 0.54 (0.52-0.57)
All facilities
Nonprofit (n = 187 317) 148 593 (79.3) 36 266 (19.4) 1 [Reference] 6608 (3.5) 1 [Reference] 14 236 (7.6) 1 [Reference]
For-profit (n = 1 291 247) 1 192 793 (92.4) 85 414 (6.6) 0.33 (0.32-0.33) 17 154 (1.3) 0.40 (0.39-0.41) 35 054 (2.7) 0.39 (0.38-0.40)
Patient-Level Characteristics
at Start of Dialysisa
Age group, y
18-29 18 152 (57.2) 11 251 (35.4) 4.21 (4.12-4.30) 4206 (13.2) 10.8 (10.3-11.3) 5709 (18.0) 5.48 (5.30-5.68)
30-39 46 118 (68.6) 16 840 (25.1) 2.94 (2.88-2.99) 4280 (6.4) 5.24 (5.01-5.47) 9699 (14.4) 4.53 (4.40-4.67)
40-49 111 700 (77.9) 27 361 (19.1) 2.31 (2.27-2.35) 5301 (3.7) 3.09 (2.96-3.22) 12 296 (8.6) 2.86 (2.78-2.94)
50-59 230 534 (85.7) 35 491 (13.2) 1.70 (1.68-1.73) 5535 (2.1) 1.83 (1.76-1.91) 12 694 (4.7) 1.84 (1.78-1.89)
60-69 337 535 (92.5) 25 839 (7.1) 1 [Reference] 3679 (1.0) 1 [Reference] 7557 (2.1) 1 [Reference]
≥70 597 347 (99.1) 4898 (0.8) 0.14 (0.13-0.14) 761 (0.1) 0.15 (0.14-0.17) 1335 (0.2) 0.16 (0.15-0.17)
Sex
Male 733 434 (89.7) 75 081 (9.2) 1 [Reference] 14 792 (1.8) 1 [Reference] 30 510 (3.7) 1 [Reference]
Female 607 952 (92.0) 46 599 (7.1) 0.75 (0.74-0.76) 8970 (1.4) 0.74 (0.72-0.76) 18 780 (2.8) 0.73 (0.72-0.74)
Race/ethnicity
Non-Hispanic white 744 464 (92.4) 51 267 (6.4) 1 [Reference] 14 763 (1.8) 1 [Reference] 22 036 (2.7) 1 [Reference]
Non-Hispanic black 373 135 (89.8) 39 641 (9.5) 1.53 (1.50-1.55) 4044 (1.0) 0.85 (0.82-0.88) 16 195 (3.9) 0.96 (0.93-0.98)
Hispanic white 155 183 (86.8) 21 491 (12.0) 1.21 (1.19-1.23) 3572 (2.0) 0.42 (0.40-0.43) 7582 (4.2) 0.88 (0.86-0.90)
Otherg 68 604 (87.3) 9281 (11.8) 1.57 (1.54-1.61) 1383 (1.8) 0.78 (0.73-0.82) 3477 (4.4) 1.08 (1.04-1.12)
Insurance coverageh
Medicare 524 311 (96.6) 17 125 (3.2) 0.20 (0.20-0.21) 2456 (0.5) 0.11 (0.11-0.12) 5472 (1.0) 0.19 (0.18-0.19)
Medicaid 350 489 (92.8) 24 333 (6.4) 0.37 (0.37-0.38) 2998 (0.8) 0.18 (0.18-0.19) 9495 (2.5) 0.35 (0.34-0.36)
Employer 188 766 (78.8) 43 833 (18.3) 1 [Reference] 11 764 (4.9) 1 [Reference] 19 349 (8.1) 1 [Reference]
None 84 277 (81.6) 17 283 (16.7) 0.74 (0.72-0.75) 2554 (2.5) 0.41 (0.40-0.43) 7800 (7.6) 0.63 (0.62-0.65)
Otheri 84 717 (85.1) 13 069 (13.2) 0.71 (0.69-0.72) 3070 (3.1) 0.63 (0.61-0.66) 5366 (5.4) 0.66 (0.64-0.68)
Attributed cause of ESKD
Diabetes 636 630 (91.7) 48 240 (6.9) 1 [Reference] 7028 (1.0) 1 [Reference] 20 670 (3.0) 1 [Reference]
Hypertension 407 538 (92.7) 30 133 (6.9) 1.02 (1.01-1.04) 4486 (1.0) 1.04 (1.00-1.08) 11 383 (2.6) 0.85 (0.83-0.87)
Other disease 215 645 (91.1) 19 283 (8.1) 1.26 (1.24-1.28) 4940 (2.1) 2.22 (2.14-2.30) 7631 (3.2) 1.01 (0.99-1.04)
Glomerulonephritis 81 573 (75.6) 24 024 (22.3) 3.00 (2.96-3.05) 7308 (6.8) 5.95 (5.76-6.15) 9606 (8.9) 2.17 (2.12-2.22)
Dialysis typej
In-center hemodialysis 1 235 615 (92.2) 92 673 (6.9) 1 [Reference] 16 947 (1.3) 1 [Reference] 37 627 (2.8) 1 [Reference]
Peritoneal dialysis 80 218 (73.7) 25 352 (23.3) 3.86 (3.81-3.92) 5983 (5.5) 4.58 (4.45-4.72) 10 118 (9.3) 4.53 (4.44-4.64)
Home hemodialysis 17 901 (82.1) 3612 (16.6) 2.39 (2.31-2.47) 772 (3.5) 2.67 (2.48-2.87) 1456 (6.7) 2.25 (2.13-2.37)
Patient-Level Comorbidities at Start of Dialysis
and Measures of Access to Transplantationa
Hypertension 1 130 062 (90.6) 104 489 (8.4) 1.07 (1.05-1.09) 19 403 (1.6) 0.77 (0.74-0.79) 42 009 (3.4) 1.06 (1.03-1.09)
Diabetes 655 158 (92.2) 46 622 (6.6) 0.70 (0.70-0.71) 6413 (0.9) 0.42 (0.41-0.43) 18 896 (2.7) 0.85 (0.84-0.87)
Congestive heart failure 470 977 (96.0) 18 107 (3.7) 0.42 (0.41-0.42) 2451 (0.5) 0.28 (0.27-0.29) 5888 (1.2) 0.39 (0.38-0.40)
BMI >35k 252 850 (91.7) 21 749 (7.9) 0.87 (0.86-0.88) 3177 (1.2) 0.61 (0.59-0.64) 7049 (2.6) 0.63 (0.61-0.65)
Other cardiac disease 199 097 (96.3) 7126 (3.4) 0.49 (0.47-0.5) 945 (0.5) 0.32 (0.30-0.35) 1988 (1.0) 0.44 (0.42-0.46)
Atherosclerotic heart disease 197 145 (96.0) 7575 (3.7) 0.47 (0.46-0.49) 1032 (0.5) 0.32 (0.31-0.35) 2075 (1.0) 0.39 (0.37-0.41)
Peripheral vascular disease 191 483 (96.3) 6485 (3.3) 0.41 (0.40-0.42) 934 (0.5) 0.30 (0.28-0.32) 2092 (1.1) 0.39 (0.37-0.40)
Cerebrovascular disease 138 017 (96.3) 4878 (3.4) 0.44 (0.42-0.45) 642 (0.4) 0.29 (0.27-0.32) 1602 (1.1) 0.41 (0.39-0.43)
COPD 139 765 (98.0) 2630 (1.8) 0.26 (0.25-0.27) 400 (0.3) 0.21 (0.19-0.23) 792 (0.6) 0.25 (0.24-0.27)
Cancer 106 370 (97.0) 3064 (2.8) 0.41 (0.40-0.43) 641 (0.6) 0.45 (0.42-0.49) 946 (0.9) 0.38 (0.35-0.40)
Tobacco use 85 877 (93.0) 5734 (6.2) 0.72 (0.70-0.74) 1008 (1.1) 0.65 (0.61-0.69) 2304 (2.5) 0.73 (0.70-0.76)
Nephrology care before ESKDl 563 625 (90.5) 53 496 (8.6) 1.00 (0.99-1.02) 8777 (1.4) 1.18 (1.15-1.22) 19 148 (3.1) 1.11 (1.08-1.13)
Not informed of transplant options due to medical reasonsm 79 280 (99.0) 777 (1.0) 0.16 (0.15-0.17) 87 (0.1) 0.09 (0.08-0.12) 218 (0.3) 0.15 (0.13-0.17)
Dialysis Facility-Level Characteristics
ESRD Network geographic areasn
Northeasto 214 813 (90.0) 21 864 (9.1) 1 [Reference] 21 684 (9.1) 1 [Reference] 8115 (3.4) 1 [Reference]
Southp 554 157 (91.1) 48 866 (8.0) 0.83 (0.82-0.84) 48 866 (8.0) 0.67 (0.65-0.70) 20 171 (3.3) 0.90 (0.88-0.92)
Midwestq 303 183 (90.8) 25 581 (7.7) 0.82 (0.8-0.83) 25 581 (7.7) 1.21 (1.16-1.26) 11 664 (3.5) 1.04 (1.01-1.07)
Westr 269 233 (90.3) 25 549 (8.6) 0.87 (0.86-0.89) 25 549 (8.6) 0.84 (0.81-0.88) 9340 (3.1) 0.82 (0.79-0.84)
Metropolitan rural-urban classifications
Metropolitan area 1 115 432 (83.9) 104 943 (8.5) 1 [Reference] 20 002 (1.6) 1 [Reference] 42 315 (3.4) 1 [Reference]
Rural area 213 870 (16.1) 15 626 (6.7) 0.81 (0.74-0.88) 3539 (1.5) 0.97 (0.90-1.05) 6540 (2.8) 0.89 (0.82-0.96)
Distance from assigned facility to nearest transplant center, median (IQR), mt 16.7 (6.1-53.2) 9.0 (2.1-36.1) 1.00 (1.00-1.00) 9.9 (2.2-38.3) 1.00 (1.00-1.00) 9.0 (2.4-35.3) 1.00 (1.00-1.00)

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; ESKD, end-stage kidney disease; ESRD, end-stage renal disease; IQR, interquartile range.

a

Baseline characteristics were obtained at the time the CMS-2728 form was completed.

b

Defined as death or end of follow-up (December 31, 2016).

c

Univariate Cox proportional hazard model determined the association between patient- and facility-level characteristics and placement on the deceased donor waiting list. Time to follow-up was defined as start of dialysis to placement on waiting list or censor date (end of study or death).

d

Univariate Cox proportional hazard model determined the association between patient- and facility-level characteristics and receipt of a living donor kidney transplant. Time to follow-up was defined as start of dialysis to living donor kidney transplant or censor date (end of study or death).

e

Univariate Cox proportional hazard model determined the association between patient- and facility-level characteristics receipt of a deceased donor kidney transplant. Time to follow-up was defined as start of dialysis to deceased donor kidney transplant or censor date (end of study or death).

f

Patients were assigned to the last dialysis facility from which they were receiving treatment when the outcome event of interest occurred.

g

Defined as Asian, Middle Eastern, Native American, Pacific Islander, or multiracial.

h

There were missing data for 115 322 patients (7.8%).

i

This category was collected and defined on the CMS-2728 form and was not further defined.

j

There were missing data for 7805 patients (0.5%).

k

Calculated as weight in kilograms divided by height in meters squared.

l

There were missing data for 546 900 patients (37.0%).

m

Obtained from item 27 on the CMS-2728 form. The attending physician recorded no if the patient had not been informed of their transplant options and entered all the reasons why a kidney transplant was not an option for the patient at that time.

n

Obtained from the Dialysis Facility Report, 2013-2016.

o

Network 1: Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont; Network 2: New York; Network 3: New Jersey; and Network 4: Delaware and Pennsylvania.

p

Network 5: District of Columbia, Maryland, Virginia, and West Virginia; Network 6: Georgia, North Carolina, and South Carolina; Network 7: Florida; Network 8: Alabama, Mississippi, and Tennessee; Network 13: Arkansas, Louisiana, and Oklahoma; and Network 14: Texas.

q

Network 9/10: Illinois, Indiana, Kentucky, and Ohio; Network 11: Michigan, Minnesota, North Dakota, South Dakota, and Wisconsin; and Network 12: Iowa, Kansas, Missouri, and Nebraska.

r

Network 15: Arizona, Colorado, Nevada, New Mexico, Utah, and Wyoming; Network 16: Alaska, Idaho, Montana, Oregon, and Washington; Network 17: Hawaii and northern California; and Network 18: southern California.

s

Obtained from the US Department of Agriculture Rural and Urban Continuum Code. There were missing data for 13 322 patients (0.9%).

t

Calculated using the dialysis facility address from Dialysis Facility Compare (2013-2016) and the nearest transplant center address from the Scientific Registry of Transplant Recipients. There were missing data for 319 177 patients (21.6%).