Comparison of 1-year survival between patients initiating chronic hemodialysis under public and private health insurance: register-based data analysis from Brazil.

Autor: do Nascimento Lima H; Medicine Department, University of the Region of Joinville (Univille), Rua Rio do Sul 270, Joinville, Santa Catarina, 89202-201, Brazil. helbertlima@hotmail.com.; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. helbertlima@hotmail.com.; Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil. helbertlima@hotmail.com., Monárrez-Espino J; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK., Nerbass FB; Pró Rim Fundation, Joinville, Brazil., Moura-Neto JA; Internal Medicine Division, Bahiana School of Medicine and Public Health, Salvador, Brazil.; Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil., Sesso R; Nephrology Division, Federal University of São Paulo, Sao Paulo, Brazil.; Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil., Lugon JR; Nephrology Division, Universidade Federal Fluminense (UFF), Niterói, Brazil.; Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil.
Jazyk: angličtina
Zdroj: International urology and nephrology [Int Urol Nephrol] 2024 Sep; Vol. 56 (9), pp. 3013-3022. Date of Electronic Publication: 2024 Apr 05.
DOI: 10.1007/s11255-024-04018-4
Abstrakt: Purpose: Brazil has one of the world's highest numbers of patients on hemodialysis (HD). Most dialysis centers are private and perform HD for patients with private and public health insurance. We compared 1-year survival between patients initiating chronic HD with public and private health insurance.
Methods: This is an HD register-based retrospective cohort. Adult patients starting HD from January 2011 to December 2021 were included. Survival analysis was stratified according to the period entered in the HD register. Multivariate Cox regression focused on 1-year survival differences between private and public patients.
Results: In the final sample (n = 5114), 68.5% of participants had public and 31.3% to private health insurance, with overall 1-year survival of 92.8% and 89.9%, respectively (p = 0.002). Crude analysis showed a slightly higher survival rate among patients with public health insurance than those with private health insurance (91 vs. 87%, p = 0.030) in the first period (2019-21). However, the adjusted hazard ratio (HR) did not remain significantly higher for patients with private health insurance compared to those with public health insurance (HR = 1.07; 95% CI 0.80-1.41; p = 0.651), even after propensity score matching of the groups by several baseline features.
Conclusion: Brazilian chronic HD patients funded by either private health plans or the public system have a similar 1-year mortality risk after controlling for several sociodemographic and clinical parameters.
(© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)
Databáze: MEDLINE
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