Development of a registry for gender equity analysis (ASTREG-WIT-KT) in Asian-Pacific countries
Miyeun Han1, Germaine Wong2, Vivek Kute3, Yuki Nakagawa4, Hsu-Han Wang5, Mel- Hatra Arakama6, Jong Cheol Jeong7, Yun Yung Cho8, Khin Thida Twin9, Jeremy Chapman10, Roslyn Mannon11, Curie Ahn12, Yeong Hoon Kim13.
1Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea; 2Centre for Renal and Transplant Research, Westmead Hospital, Sydney, Australia; 3Nephrology & Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation, Ahmedabad, India; 4Division of Urology, Juntendo University, Tokyo, Japan; 5Department of Urology, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan; 6Organ transplant Unit, National Kidney and Transplant Institute, Manila, Philippines; 7Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; 8Graduate School of Public Health , Yonsei University, Seoul, Korea; 9Department of Renal Medicine, University of Medicine (I), Yangon, Myanmar; 10Westmead Institute for Medical Research, University of Sydney, Sydney, Australia; 11Division of Nephrology, University of Nebraska Medical Center, Omaha, NE, United States; 12Department of Internal Medicine, National Medical Center, Seoul, Korea; 13Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
Steering Comm Members of ASTREG-WIT-KT.
Introduction: Gender inequity in kidney transplantation (KT) is a global issue but may be more evident in Asia than in Western countries because of social, cultural, and economic influences. In order to elucidate the reasons and define solutions and strategies to reduce and eliminate health disparities, we have established a web-based registry (ASTREG-WIT-KT) and analyzed data on proportions of female in kidney donation and transplantation from 6 Asian-Pacific countries.
Methods: An online registry was constructed using the platform of the Asian Transplantation Registry (ASTREG-WIT-KT, http://ecrf.astreg.org). We collected data (2015-2019) on 360 variables related to gender, ethnicity and other socioeconomic factors about kidney donation and transplantation, dialysis, waiting list, and chronic kidney disease from 6 Asian-Pacific countries of Australia, India, Japan, Korea, Philippines, and Taiwan and analyzed. ASTREG-WIT-KT has been built as an online platform for collecting and visualizing gender-related statistics of kidney transplantation from aggregated national or institutional databases. Data are presented according to different years and countries and the trend over 5 years is analyzed with the joinpoint regression.
Results: We found that the proportion of female living donors was the highest in India (ranged from 72.3 to 81.1%) and the lowest in the Philippines (ranged from 37.5 to 41.6%). The proportion of female living donors was over 50% in all participating countries except the Philippines. Australia (annual percent change (APC) -1.5, p = 0.015) and Japan (APC -0.9, P = 0.024) showed decreasing trend of female living donors for five years. The proportion was the highest for female spousal donors. All participating countries showed less than 50% of female recipients received a living donor KT (LDKT). The proportion of female recipients who received a LDKT ranged from 16.0 to 48.6%. Taiwan (37.1-48.6%) showed the highest and India (14.8-19.1%) showed the lowest female recipient proportions. The proportion of female recipients with deceased donor KT ranged from 21.5 to 50.0%. The proportion of female recipients in DDKT showed increasing trend in Australia (APC 1.8, P = 0.004). Proportions of females on the waiting list were less than 50% among all countries with available data.
Conclusion: ASTREG-WIT-KT is established to support collaborative studies on promoting gender equity in KT, especially in Asian -Pacific countries. Our preliminary data showed that gender inequity existed and persisted, showing large differences in female fractions for the living kidney donor and the recipient. A data-based approach for identifying both biological and social factors will be necessary for achieving gender equity in KT.
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