Mortality in Patients With Chronic Renal Disease Without Health Insurance in Mexico: Opportunities for a National Renal Health Policy
| Autor: | Mario Cortes-Pérez, Gloria García-Villalobos, Arturo Reding, Geovana Martin-Alemañy, Clara Rocío Hernández-Arciniega, Héctor Hinojosa-Heredia, Monserrat Pérez-Navarro, Guillermo Cantú-Quintanilla, Adrian Rodríguez-Matías, Ricardo Correa-Rotter, Ana Yetzin Camacho-Aguirre, Ernesto Chávez-López, Gregorio T. Obrador, Angel Valdez-Ortiz, Francisco Navarro-Reynoso, Irma Gómez-Guerrero, Rafael Valdez-Ortiz, Ma. Guadalupe Olvera-Soto |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Population 030232 urology & nephrology survival analysis 03 medical and health sciences 0302 clinical medicine Clinical Research Medicine 030212 general & internal medicine Renal replacement therapy education Prospective cohort study Mexico Health policy education.field_of_study business.industry Mortality rate medicine.disease mortality Transplantation Nephrology Cohort Emergency medicine business chronic kidney disease Kidney disease |
| Zdroj: | Kidney International Reports |
| ISSN: | 2468-0249 |
| DOI: | 10.1016/j.ekir.2018.06.004 |
| Popis: | Introduction Despite a systematic increase in the coverage of patients with end-stage renal disease (ESRD) who have received dialytic therapies and transplantation over the past 2 decades, the Mexican health system currently still does not have a program to provide full coverage of ESRD. Our aim was to analyze mortality in patients with ESRD without health insurance. Methods This was a prospective cohort study of 850 patients with advanced chronic kidney disease (CKD). Risk factors associated with death were calculated using a Cox's proportional hazards model. We used the statistical package SPSS version 22.0 for data analysis. Results The mean age of patients was 44.8 ± 17.2 years old. At the time of hospital admission, 87.6% of the population did not have a social security program to cover the cost of renal replacement treatment, and 91.3% of families had an income below US$300 per month. During the 3 years of the study, 28.8% of the cohort patients were enrolled in 1 of Mexico's social security programs. The 3-year mortality rate was of 56.7% among patients without access to health insurance, in contrast to 38.2% of patients who had access to a social security program that provided access to renal replacement therapy (P < 0.001). Risk factor analysis revealed that not having health insurance increased mortality (risk ratio: 2.64, 95% confidence intervals: 1.84−3.79; P = 0.001). Conclusion Mexico needs a coordinated National Kidney Health and Treatment Program. A program of this nature should provide the basis for an appropriate educational and intervention strategy for early detection, prevention, and treatment of patients with advanced chronic kidney disease. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|