Health inequalities and kidney disease: assessing equity across the renal care pathway using routinely collected data

The impact of chronic kidney disease (CKD) is unevenly distributed across socio-demographic groups in England, contributing to disparities in healthcare access and outcomes. This study presents a baseline assessment of equity in renal care pathways across England, utilising health equity audit methodology, to facilitate future comparisons assessing intervention impact.

This study used a retrospective, observational design. Data from three routinely available sources of healthcare activity data; CVDPREVENT, the Secondary Uses Service, and the UK Renal Registry (UKRR) were analysed to evaluate disparities in access to renal care pathways. More than twenty different dependent variables were analysed, by age, sex, ethnicity, socioeconomic status, and geography. We calculated the proportion of patients or rates per population for each category of explanatory variables.

The baseline equity assessment highlighted substantial disparities in access to kidney care across primary, secondary, and specialised services. Findings showed that; older adults faced lower access to transplants and peritoneal dialysis, while younger adults, particularly young men, were less likely to attend outpatient appointments. Socio-economic inequalities were evident, with patients from deprived areas having higher rates of late presentation and non-attendance, alongside reduced access to transplants and peritoneal dialysis. Asian patients demonstrated higher testing rates, whereas Black patients experienced higher non-attendance rates and lower transplant access.

The study highlights the utility of the health equity audit for identifying inequities and provides a replicable methodology for local systems. Addressing these findings requires targeted interventions and systemic changes to reduce avoidable inequities and improve healthcare outcomes for all patients with CKD.