Post-Kidney Transplant Well-Being and Healthcare Access: Urban-Rural Disparities in Kazakhstan

Abstract Background In Kazakhstan, disparities between urban and rural regions may impact post-transplant well-being. This study examined the urban-rural gap in psychological well-being after KTx and explored whether healthcare access and treatment adherence mediate this relationship. Methods A cross-sectional survey was conducted among 223 KTx recipients. Well-being was measured using the WHO-5 Index. Other variables included ability to follow treatment, access to medications, post-transplant monitoring, and consultations. One-way ANOVA, correlation, and mediation analyses were used to evaluate group differences and indirect effects. Results Patients in national-level cities had the highest well-being and service access, while rural patients reported the lowest monitoring and greater consultation difficulties. Post-hoc analyses confirmed significant rural-urban differences. Well-being correlated positively with treatment adherence (r = 0.413, p<.001) and monitoring (r = 0.181, p=.007), and negatively with medication access issues (r=-0.177, p=.008) and consultation barriers (r=-0.292, p<.001). Though the direct link between residence and well-being was not significant (p=.356), mediation analysis revealed significant indirect effects. Post-transplant monitoring (beta=0.058, p=.039) and consultation access (beta=0.080, p=.002) significantly mediated the relationship between residence and well-being, with consultation access being the strongest mediator. Conclusions Urban-rural disparities in well-being among KTx recipients are largely driven by unequal access to post-transplant services. Expanding follow-up and consultation access in rural areas may improve outcomes and reduce geographic health inequalities. Funding: This research has been funded by the Committee of Science of the Ministry of Science and Higher Education of the Republic of Kazakhstan (Non-invasive methods for diagnosis of transplant rejection as a predictor of long-term graft survival, No. BR21882206). Key messages • Kidney transplant recipients in rural areas of Kazakhstan report lower psychological well-being, largely due to limited access to follow-up care and medical consultations. • Improving post-transplant service availability in underserved regions may reduce geographic health inequalities and enhance patient outcomes.