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

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."