This article describes a simulation study that attempted to estimate the effect of socioeconomic status on access to a cadaver kidney transplant after controlling for self-reported health/functional status and attitudes about treatment alternatives (which are likely to confound the association between socioeconomic status and access to treatment).

The authors demonstrate that if socioeconomic status by itself no longer influenced rates (that is, if the effect of socioeconomic status were removed), race, age, and income level differences in kidney transplant waiting lists and transplants would diminish. With regard to race specifically, the difference in waiting list entry rates for black patients versus more advantaged persons decreased from 93/1,000 patients to 39/1,000 patients. Additionally, under the same scenario, the race difference in transplant rates diminished from 236/1,000 patients to 177/1,000 patients.

The authors conclude that socioeconomic status itself is an important contributor to race, age and income differences, rather than a proxy measure for group differences in heath/functional status or attitudes toward treatment.