The highest vs lowest quartile of patient to social worker ratio was significantly associated with a 15% and 5% reduced incidence of transplantation and waitlisting. Reduced access to transplantation associated with the highest vs lowest quartile of patient to staff ratio was more pronounced among patients starting dialysis when they were younger than 22 years. The highest vs lowest quartile of patient to social worker ratio was significantly associated with a 13% and 26% lower incidence of waitlisting and transplantation. For the study population as a whole, the median patient to staff ratios were 14.4 patients per nurse and 91 patients per social worker. Approximately 40% of patients received a transplant during a median follow-up of 2.6 years.