The Unemployed Are Less Likely to Receive Kidney Transplants

Recent research concludes that a person with a job is 2.24 times more likely to be put on a list for a transplant than someone who is unemployed.

National Journal
Brian Resnick
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Brian Resnick
Aug. 21, 2013, 8:52 a.m.

Un­em­ploy­ment is hor­rible for your health.

This fact is well-doc­u­mented: Long-term un­em­ploy­ment is as­so­ci­ated with de­clines in men­tal well-be­ing and in­creases in mor­tal­ity. In all, “los­ing a job be­cause of an es­tab­lish­ment clos­ure in­creased the odds of fair or poor health by 54 per­cent, and among re­spond­ents with no preex­ist­ing health con­di­tions, it in­creased the odds of a new likely health con­di­tion by 83 per­cent,” a 2009 study in the journ­al Demo­graphy con­cluded. Even those un­em­ployed who re­tain health in­sur­ance after be­ing axed from their jobs have great­er com­plic­a­tions, as this chart from the Cen­ters for Dis­ease Con­trol and Pre­ven­tion in­dic­ates:

But per­haps the more dis­turb­ing in­dic­a­tion is this: Com­bined with the in­creased like­li­hood of health prob­lems, the un­em­ployed have a de­creased like­li­hood of re­ceiv­ing the ap­pro­pri­ate in­ter­ven­tion. This is true even when they re­tain in­sur­ance. Ac­cord­ing to the CDC, “Among adults with private health in­sur­ance, one in sev­en (14.7 per­cent) un­em­ployed adults ex­per­i­enced either a delay or lack of needed med­ic­al care be­cause of cost com­pared with 8.7 per­cent of em­ployed adults.”

This holds true even when the in­ter­ven­tion may mean life or death. End-stage ren­al dis­ease, “the com­plete or al­most com­plete fail­ure of the kid­neys to work,” isn’t pleas­ant. In or­der for a per­son to sur­vive it, they need either con­tinu­al dia­lys­is or a trans­plant. But re­cent re­search re­veals a dis­par­ity fall­ing along em­ploy­ment lines.

In a sur­vey of 429,409 pa­tients with end-stage ren­al dis­ease, those who had jobs were 2.24 times more likely to be placed on a wait­ing list for a kid­ney trans­plant. Once placed on a list, the em­ployed full-time were 1.65 times more likely to re­ceive the trans­plant. And hav­ing in­sur­ance didn’t help the un­em­ployed in this case either. When the re­search­ers ran the num­bers on those un­em­ployed who had in­sur­ance, they found “the res­ults to be es­sen­tially the same and still sig­ni­fic­ant.”

And if all of that isn’t down­er enough for you, con­sider this: The un­em­ployed are much, much more likely to be in need of a kid­ney trans­plant. A 10-year study found “un­em­ploy­ment af­fects up to 75 per­cent of in­cid­ent ES­RD [end-stage ren­al dis­ease] pa­tients,” and “this rate in­creases with time on dia­lys­is.”

So, people with ren­al dis­eases tend to be un­em­ployed, but the un­em­ployed are less likely to re­ceive kid­ney trans­plants when things get dire. The re­search­ers on the trans­plant study sug­gest a couple of reas­ons why the dis­par­ity hap­pens:

The un­em­ployed may be seen as ris­ki­er pa­tients. “One of the primary con­cerns of trans­plant cen­ters is the re­cip­i­ent’s abil­ity to af­ford im­mun­osup­press­ive med­ic­a­tions post-trans­plant,” the au­thors write. Those drugs can cost between $2,000 and $14,000  a year. In­ab­il­ity to pay for the drugs  “could be im­plic­ated in al­most half the cases and might be per­ceived as bar­ri­er by a trans­plant pro­gram.”

Those stressed with un­em­ploy­ment may not be seek­ing care im­me­di­ately, which can “con­trib­ute to late re­fer­rals by neph­ro­lo­gists and delayed eval­u­ations by trans­plant cen­ters.”

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