Mortality risk disparities in children receiving chronic renal replacement therapy for the treatment of end-stage renal disease across Europe: an ESPN-ERA/EDTA registry analysis
Autor: | Laura Espinosa, Elisabeth A.M. Cornelissen, Sylvie Cloarec, Ilona Zagozdzon, Sergey Baiko, Anna Bjerre, Marjolein Bonthuis, Diamant Shtiza, Nicholas C. Chesnaye, Rosário Stone, Kitty J. Jager, Rebecca Holman, Jérôme Harambat, Franz Schaefer, James G. Heaf, Jaap W. Groothoff, Esra Baskin, Karlijn J. van Stralen |
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Přispěvatelé: | Medical Informatics, ARD - Amsterdam Reproduction and Development, Other departments, APH - Aging & Later Life, APH - Quality of Care, Paediatric Nephrology, APH - Methodology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, APH - Global Health, APH - Health Behaviors & Chronic Diseases, ACS - Pulmonary hypertension & thrombosis |
Rok vydání: | 2017 |
Předmět: |
Male
Pediatrics medicine.medical_specialty Adolescent medicine.medical_treatment Population 030232 urology & nephrology Health Services Accessibility End stage renal disease Young Adult 03 medical and health sciences 0302 clinical medicine Humans Medicine Registries 030212 general & internal medicine Renal replacement therapy Healthcare Disparities Child education Proportional Hazards Models education.field_of_study business.industry Mortality rate Hazard ratio Infant Newborn Infant General Medicine Explained variation Health equity Europe Renal Replacement Therapy Child mortality Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11] Child Preschool Kidney Failure Chronic Female business |
Zdroj: | The Lancet (London), 389, 10084, pp. 2128-2137 The Lancet (London), 389, 2128-2137 Lancet, 389(10084), 2128-2137. Elsevier Limited |
ISSN: | 0140-6736 2128-2137 |
Popis: | Item does not contain fulltext BACKGROUND: We explored the variation in country mortality rates in the paediatric population receiving renal replacement therapy across Europe, and estimated how much of this variation could be explained by patient-level and country-level factors. METHODS: In this registry analysis, we extracted patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. We included incident patients younger than 19 years receiving renal replacement therapy. Adjusted hazard ratios (aHR) and the explained variation were modelled for patient-level and country-level factors with multilevel Cox regression. The primary outcome studied was all-cause mortality while on renal replacement therapy. FINDINGS: Between Jan 1, 2000, and Dec 31, 2013, the overall 5 year renal replacement therapy mortality rate was 15.8 deaths per 1000 patient-years (IQR 6.4-16.4). France had a mortality rate (9.2) of more than 3 SDs better, and Russia (35.2), Poland (39.9), Romania (47.4), and Bulgaria (68.6) had mortality rates more than 3 SDs worse than the European average. Public health expenditure was inversely associated with mortality risk (per SD increase, aHR 0.69, 95% CI 0.52-0.91) and explained 67% of the variation in renal replacement therapy mortality rates between countries. Child mortality rates showed a significant association with renal replacement therapy mortality, albeit mediated by macroeconomics (eg, neonatal mortality reduced from 1.31 [95% CI 1.13-1.53], p=0.0005, to 1.21 [0.97-1.51], p=0.10). After accounting for country distributions of patient age, the variation in renal replacement therapy mortality rates between countries increased by 21%. INTERPRETATION: Substantial international variation exists in paediatric renal replacement therapy mortality rates across Europe, most of which was explained by disparities in public health expenditure, which seems to limit the availability and quality of paediatric renal care. Differences between countries in their ability to accept and treat the youngest patients, who are the most complex and costly to treat, form an important source of disparity within this population. Our findings can be used by policy makers and health-care providers to explore potential strategies to help reduce these health disparities. FUNDING: ERA-EDTA and ESPN. |
Databáze: | OpenAIRE |
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