Fan Z Joyce, Lackland Daniel T, Lipsitz Stuart R, Nicholas Joyce S, Egan Brent M, Tim Garvey W, Hutchison Florence N
SHARP, Washington State Department of Labor and Industries, Olympia, WA, USA.
Health Place. 2007 Mar;13(1):179-87. doi: 10.1016/j.healthplace.2005.12.002. Epub 2006 Jan 27.
To assess the geographical patterns of end-stage renal disease (ESRD) incidence and to identify the risk factors on the regional differences, the authors conducted an ecological study on incidence of ESRD and related risk factors in the 46 counties of South Carolina (SC). Age and gender adjusted, race specific incidence rates for each county in SC were calculated for the 11,346 ESRD patients of all ages who registered in the United States Renal Data Systems Network 6 from 1990 to 1999. County level exposure measures on population physician density, hospitalization rates of diabetes and hypertension, per capita income, percent college degree, and percent below poverty were evaluated. There was a significant increase in mean incidence rates of ESRD from 1990 to 1999 in SC (p<0.0001). The incidence rates were consistently higher in rural than in urban counties. Population physician density (relative risk (RR) 0.49, 95% confidence interval (95%Cl, 0.41-0.58) and rural residence (adjusted RR 1.66, 95%Cl 1.59-1.74) were significantly associated with ESRD incidence. The strong relationship between ESRD and physician density suggests that access to adequate treatment of diabetes and hypertension is of paramount importance for ESRD prevention, and has important public policy implications.
为评估终末期肾病（ESRD）发病率的地理分布模式并确定区域差异的风险因素，作者对南卡罗来纳州（SC）46个县的ESRD发病率及相关风险因素进行了一项生态学研究。对1990年至1999年在美国肾脏数据系统网络6登记的11346例各年龄段ESRD患者，计算了SC各县经年龄和性别调整后的种族特异性发病率。评估了县级层面的人口医生密度、糖尿病和高血压住院率、人均收入、大学学位百分比以及贫困线以下人口百分比等暴露指标。1990年至1999年，SC的ESRD平均发病率显著上升（p<0.0001）。农村县的发病率始终高于城市县。人口医生密度（相对风险（RR）0.49，95%置信区间（95%Cl，0.41 - 0.58））和农村居住情况（调整后RR 1.66，95%Cl 1.59 - 1.74）与ESRD发病率显著相关。ESRD与医生密度之间的紧密关系表明，获得糖尿病和高血压的充分治疗对预防ESRD至关重要，且具有重要的公共政策意义。
