Rationale & Objective

Although existing studies have reported adverse health outcomes after kidney donation, its socioeconomic impact on living donors requires further study.

Study Design

A retrospective observational cohort study including a matched comparison group.

Setting & Participants

1,285 living kidney donors from 7 tertiary hospitals between 2003 and 2016, and a matched comparison group consisting of the same number of health screening examinees with similar baseline clinical characteristics and socioeconomic status. All participants were receiving Korean national health insurance.

Exposure

Kidney donation as reflected in the Korean National Health Insurance System (NHIS) database.

Outcome

Changes in household economic status estimated by Korean national health insurance fees and changes in employment status reflected in the NHIS database.

Analytical Approach

The outcomes of the donor group and matched control group were compared annually using multivariable logistic regression analyses adjusted for clinical and demographic characteristics.

Results

The median ages of the donors and matched controls were 45 and 46 years, respectively; 44.6% of both groups were male. Compared to the comparison group, living donors were at higher risk of being unemployed or losing employment during the first 2 years after donation (eg, first-year loss of employment: odds ratio (OR), 2.27 [95% CI, 1.55-3.33]); however, this association did not persist. Donors also had a significantly lower odds of improvement in economic status (OR, 0.57 [95% CI, 0.47-0.71]) and a higher odds of deterioration in financial status (OR, 1.54 [95% CI, 1.23-1.93]) in the first year after transplantation and subsequently.

Limitations

Unmeasured differences between donors and matched controls creating residual selection bias and confounding.

Conclusions

Living kidney donors may suffer loss of employment and poor economic status after their voluntary donation. The socioeconomic impact on these donors should be considered in conjunction with the potential long-term adverse health outcomes after donation.

中文翻译：

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捐肾对活体捐献者的经济影响：韩国队列研究

基本原理和目标

尽管现有研究报告了肾脏捐赠后的不良健康后果，但其对活体捐赠者的社会经济影响需要进一步研究。

学习规划

一项包括匹配对照组的回顾性观察性队列研究。

设置与参与者

2003 年至 2016 年间来自 7 家三级医院的 1,285 名活体肾脏供体，以及由相同数量的具有相似基线临床特征和社会经济地位的健康筛查受试者组成的匹配对照组。所有参与者都接受了韩国国民健康保险。

接触

韩国国民健康保险系统 (NHIS) 数据库中反映的肾脏捐赠。

结果

韩国国民健康保险费估计的家庭经济状况变化和 NHIS 数据库中反映的就业状况变化。

分析方法

每年使用针对临床和人口学特征调整的多变量逻辑回归分析比较供体组和匹配对照组的结果。

结果

供体和匹配对照的中位年龄分别为 45 岁和 46 岁；两组中44.6%为男性。与对照组相比，活体捐献者在捐赠后的头 2 年内失业或失业的风险更高（例如，第一年失业：优势比 (OR)，2.27 [95% CI，1.55-3.33 ]); 然而，这种关联并没有持续下去。捐赠者的经济状况改善几率（OR，0.57 [95% CI，0.47-0.71]）和财务状况恶化的几率也显着降低（OR，1.54 [95% CI，1.23-1.93]）移植后的第一年和随后。

限制

供体和匹配对照之间未测量的差异会产生残余选择偏差和混杂。

结论

活体肾脏捐献者在自愿捐献后可能会失去就业和经济状况不佳。对这些捐赠者的社会经济影响应与捐赠后潜在的长期不良健康后果一起考虑。