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. Author manuscript; available in PMC: 2020 Mar 10.
Published in final edited form as: JAMA. 2019 Sep 10;322(10):957–973. doi: 10.1001/jama.2019.12803

Table 3.

Crude and Adjusted Hierarchical Cox Proportional Hazard Ratios Between Dialysis Facility Ownership and Placement on the Deceased Donor Kidney Transplantation Waiting List, Receipt of a Living Donor Kidney Transplant, or Deceased Donor Kidney Transplant by Patient-Level and Facility-Level Characteristics, 2000–2016a

Cumulative Incidence Difference, % (95% CI)b Hazard Ratio (95% CI)
At 3 y At 5 y At 10 y Crude Model
(n = 1 478 564)		 Adjusted for
Demographics
(n = 1 478 564)c 		+ Clinical
Characteristics
(n = 1 478 506)d 		+ Socioeconomic
and Geographic
Characteristics
(n = 1 478 506)e
Placement on Deceased Donor Kidney Transplantation Waiting List (n = 121680)
Nonprofit dialysis facilities
 Small chains 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
 Independent 17.1 (16.8 to 17.5) 18.4(18.lto 18.8) 19.1 (18.7 to 19.5) 2.74 (2.68 to 2.80) 2.46 (2.41 to 2.51) 2.48 (2.42 to 2.53) 2.36 (2.31 to 2.42)
For-profit dialysis facilities
 Large chain 1 −4.9 (−5.1 to−4.7) −5.0 (−5.2 to−4.8) −4.9 (−5.1 to−4.7) 0.58 (0.57 to 0.59) 0.58 (0.57 to 0.59) 0.57 (0.56 to 0.58) 0.57 (0.56 to 0.58)
 Large chain 2 −5.7 (−5.9 to−5.5) −5.9 (−6.1 to−5.7) −5.9 (−6.1 to−5.7) 0.52 (0.50 to 0.53) 0.53 (0.52 to 0.54) 0.55 (0.54 to 0.56) 0.54(0.53 to 0.55)
 Small chains −5.2 (−5.4 to−5.0) −5.4 (−5.7 to−5.2) −5.4 (−5.6 to−5.2) 0.55 (0.54 to 0.56) 0.56 (0.55 to 0.57) 0.56 (0.55 to 0.57) 0.56 (0.54 to 0.57)
 Independent −5.0 (−5.2 to−4.8) −5.1 (−5.3 to−4.8) −5.0 (−5.3 to−4.8) 0.59 (0.57 to 0.61) 0.61(0.60 to 0.63) 0.59 (0.57 to 0.61) 0.60 (0.58 to 0.61)
All facilities
 Nonprofit 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
 For-profit −12.5 (−12.7 to−12.3) −13.2 (−13.4 to−13.0) −13.4 (−13.6 to−13.2) 0.33 (0.32 to 0.33) 0.35 (0.34 to 0.35) 0.34 (0.34 to 0.35) 0.36 (0.35 to 0.36)
Receipt of a Living Donor Kidney Transplant (n = 23 762)
Nonprofit dialysis facilities
 Small chains 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
 Independent 2.3 (2.1 to 2.5) 2.7 (2.5 to 2.9) 3.0 (2.8 to 3.2) 1.90 (1.81 to 2.00) 1.59 (1.51 to 1.67) 1.52 (1.44 to 1.59) 1.33 (1.26 to 1.40)
For-profit dialysis facilities
 Large chain 1 −1.0 (−1.1 to−1.0) −1.1 (−1.2 to−1.0) −1.2 (−1.3 to−1.1) 0.57 (0.54 to 0.60) 0.61(0.58 to 0.63) 0.61 (0.58 to 0.63) 0.61(0.58 to 0.63)
 Large chain 2 −1.1 (−1.2 to−1.0) −1.2 (−1.3 to−1.1) −1.3 (−1.4 to−1.2) 0.55 (0.53 to 0.58) 0.59 (0.57 to 0.62) 0.62 (0.60 to 0.65) 0.60 (0.57 to 0.63)
 Small chains −1.2 (−1.3 to−1.1) −1.4 (−1.5 to−1.2) −1.4 (−1.5 to−1.3) 0.49 (0.47 to 0.52) 0.55 (0.52 to 0.58) 0.56 (0.53 to 0.59) 0.61 (0.58 to 0.64)
 Independent −1.0 (−1.1 to−0.9) −1.2 (−1.3 to−1.0) −1.2 (−1.3 to−1.1) 0.59 (0.55 to 0.62) 0.68 (0.64 to 0.72) 0.69 (0.64 to 0.73) 0.70 (0.65 to 0.74)
All facilities
 Nonprofit 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
 For-profit −2.1 (−2.1 to−2.0) −2.3 (−2.4 to−2.3) −2.5 (−2.6 to−2.4) 0.40 (0.39 to 0.41) 0.47(0.45 to 0.48) 0.49 (0.47 to 0.50) 0.52 (0.51 to 0.54)
Receipt of a Deceased Donor Kidney Transplant (n = 49 290)
Nonprofit dialysis facilities
 Small chains 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
 Independent 2.5 (2.4 to 2.7) 5.3 (5.1 to 5.6) 9.1 (8.8 to 9.4) 2.07 (2.00 to 2.14) 1.82 (1.76 to 1.88) 1.82 (1.76 to 1.88) 1.71 (1.66 to 1.77)
For-profit dialysis facilities
 Large chain 1 −1.2 (−1.3 to−1.1) −2.0 (−2.1 to−1.8) −2.5 (−2.6 to−2.3) 0.60 (0.58 to 0.62) 0.62 (0.60 to 0.64) 0.60 (0.58 to 0.62) 0.60 (0.58 to 0.62)
 Large chain 2 −1.2 (−1.3 to−1.1) −2.1 (−2.3 to−2.0) −2.9 (−3.1 to−2.8) 0.56 (0.54 to 0.58) 0.58 (0.57 to 0.60) 0.61 (0.59 to 0.63) 0.59 (0.57 to 0.61)
 Small chains −1.2 (−1.3 to−1.1) −2.1 (−2.3 to−2.0) −2.8 (−3.0 to−2.7) 0.56 (0.54 to 0.58) 0.59 (0.57 to 0.61) 0.58 (0.56 to 0.61) 0.60 (0.58 to 0.62)
 Independent −1.4 (−1.5 to−1.2) −2.4 (−2.5 to−2.2) −2.9 (−3.1 to−2.7) 0.54 (0.52 to 0.57) 0.59 (0.57 to 0.62) 0.58 (0.56 to 0.61) 0.59 (0.56 to 0. 62)
All facilities
 Nonprofit 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
 For-profit −2.3 (−2.4 to−2.2) −4.3 (−4.4 to−4.2) −6.6 (−6.7 to−6.4) 0.39 (0.38 to 0.40) 0.43 (0.42 to 0.44) 0.43 (0.42 to 0.44) 0.44 (0.44 to 0.45)
a

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

b

Calculated using the Aalen-Johansen estimator and was adjusted for competing risk of death.

c

Age, sex, and race reported at dialysis start.

d

Body mass index greater than 35, attributed cause of end-stage kidney disease, congestive heart failure, atherosclerotic heart disease, other cardiac disease, cerebrovascular disease, peripheral vascular disease, hypertension, diabetes, chronic obstructive pulmonary disease, tobacco use, cancer reported at dialysis start, and type of dialysis. Multiple imputation was used because of missing data for type of dialysis (7805 patients; 0.5%).

e

End-Stage Renal Disease Network geographic area of assigned facility; insurance coverage reported at dialysis start; facility located in metropolitan, rural-urban classification; distance from assigned dialysis facility to the nearest transplant center; and not informed of transplant options due to medical reasons. Multiple imputation was used because of missing data for insurance coverage (115 322 patients; 7.8%); distance from assigned dialysis facility to nearest transplant center (319117 patients; 21.6%); and metropolitan, rural-urban classification (13322 patients; 0.9%).