At the recent Vascular Access Society of Britain and Ireland (VASBI) annual scientific meeting (26–27 September, Cardiff, UK), Michael Corr (Belfast City Hospital, Belfast, UK) gave an abstract presentation of a retrospective study on how health literacy and socioeconomic deprivation has an impact on vascular access in patients with end-stage kidney disease (ESKD), for which he was awarded the prize for best abstract.
“Deprivation really matters.” This was Corr’s opening statement, but it also neatly summarised his perspective of the impact that socioeconomic factors can have on ESKD patients and their ability to access the treatments necessary to create or maintain vascular accesses. Whilst there has been a lot of research into how deprivation impacts our access to transplantation, Corr highlighted that there has been significantly less research into its impact on vascular access. “Most of these studies are based in the USA,” he pointed out, “which also has a very different healthcare model.” He also informed the audience that, of the 10 most deprived local authorities in the UK, seven of them are found in Northern Ireland, so “we deal with deprivation on an industrial scale and see that impact”.
To assess the level of impact that this deprivation was having on vascular access, Corr et al conducted a single-centre retrospective study, including 961 incident ESKD patients from 2011 to 2020, and used a national comprehensive assessment tool using the postcode to get a summary deprivation measure. “The thing that’s nice about the summary deprivation measures,” Corr said, “is you can break down the income, education, locale, [and] access to services,” meaning that the researchers were able to see how the impact of deprivation differs “from cities to rural areas, for example”. Once these measures were attained, Corr and his colleagues then use regression models to assess the impact deprivation had on access type at commencement of dialysis. Concentration curves were calculated for each dialysis modality, with univariate Cox regression utilised to ascertain the impact of deprivation on access at initiation of dialysis.
What they found was that concentration curves for haemodialysis (HD) via a temporary line and tunnelled line lay above the line of equality, suggesting “a predominance of more deprived individuals”. They also found the concentration curves for arteriovenous fistulas (AVFs) and peritoneal dialysis lay below the line of equality, which suggests that this group was predominantly comprised of more wealthy patients. They also identified, via the use of univariate Cox proportional hazards, that “those in the lowest quintile of education levels and income were at increased risk of commencing HD with a line compared to the least deprived quintile”.
Concluding his presentation, Corr stated that, whilst they did find that deprivation did have some impact on the type of access that patients were beginning dialysis with, it was not as statistically significant. However, education deprivation/health literacy appeared to have the largest impact on initial access. Summarising what he felt the next steps to remedying this inequality in access are, he said: “We’ve talked about patient choice and patient empowerment for the whole day. It’s really important that we present information in a format that patients are able to access.” Continuing, he added that the solution will likely include a multicentre approach to really understand the issue in the UK at large. Corr et al state in their abstract that their results prompted a review of their own educational materials, as well as a more detailed analysis of their results so that they can better understand why deprivation appears to influence dialysis modality and access within their centre—work which they state they are currently undertaking.
