Department of Nephrology, Rigshospitalet, Copenhagen, Denmark.
Nephrol Dial Transplant. 2010 Aug;25(8):2624-32. doi: 10.1093/ndt/gfq110. Epub 2010 Mar 5.
The incidence of chronic renal replacement therapy (RRT) varies markedly between Danish nephrology centres. The aim of the present study was to establish if there is regional and social variation in the incidence of chronic RRT in Denmark when analysed according to patient residence. The importance of diabetic nephropathy and patients aged 70 years or older was also studied.
Incident patients on chronic RRT in the period 1995-2006 were identified in the Danish National Registry on Regular Dialysis and Transplantation. Information on residence, income, educational status and ethnic origin was obtained from Statistics Denmark. Rates of incident RRT patients were standardized for regional differences of sex and age as well as income, educational status and ethnic origin. Poisson regression was used when comparing rates.
Age- and sex-standardized incident chronic RRT rates among individuals with low income or short educational level were higher (P < 0.0001) compared to other groups. Also, standardized rates of patients in total and patients aged 70 years or older were higher in the catchment areas of the nephrology centres located in the two largest cities than for patients with residence in other areas of the country (P < 0.0001). Standardizing for regional differences of ethnic origin did not change the rates. The incident chronic RRT rate caused by diabetic nephropathy was higher for patients with residence in the catchment area of the nephrology centre in the largest city [49 per million people (p.m.p.) (95% CI = 40-57 p.m.p.)] compared to the catchment area of the nephrology centre located in the second largest city [31 (95% CI = 26-37 p.m.p.)] and other areas [29 p.m.p. (95% CI = 26-31 p.m.p.)] in 2001-06. When standardizing for differences in income among the 30-69-year-old persons, the rate of patients with residence in the catchment area of the nephrology centre located in the largest city decreased but was still higher than in other regions (P = 0.0003).
There are marked socio-economic and regional differences in rates of incident RRT patients. The rates of incident RRT patients are highest in the catchment areas of the two largest nephrology centres and this may be partly explained by a higher frequency of end-stage diabetic nephropathy and a new treatment programme targeting frail, mainly elderly, patients.
丹麦各肾病中心慢性肾脏替代治疗（RRT）的发病率差异显著。本研究旨在分析患者居住地时，丹麦慢性 RRT 的发病率是否存在地域和社会差异。还研究了糖尿病肾病和 70 岁及以上患者的重要性。
1995-2006 年期间，丹麦国家常规透析和移植登记处确定了接受慢性 RRT 的新发病例患者。从丹麦统计局获得有关居住地、收入、教育状况和族裔的信息。根据性别和年龄、收入、教育程度和族裔的地域差异，对新发病例 RRT 患者的发病率进行了标准化。当比较发病率时，使用泊松回归。
低收入或教育程度低的个体的年龄和性别标准化慢性 RRT 发病率较高（P<0.0001）。此外，在最大两个城市的肾病中心所在地的患者的总标准化率和 70 岁及以上患者的标准化率高于该国其他地区的患者（P<0.0001）。标准化的族裔差异并不会改变发病率。最大城市的肾病中心所在地的糖尿病肾病患者的慢性 RRT 发病率较高[49 每百万人（p.m.p.）（95%CI=40-57 p.m.p.）]，而第二大城市的肾病中心所在地[31（95%CI=26-37 p.m.p.）]和其他地区[29 p.m.p.（95%CI=26-31 p.m.p.）]的患者则较低。2001-06 年。当对 30-69 岁人群的收入差异进行标准化时，位于最大城市的肾病中心所在地患者的发病率有所下降，但仍高于其他地区（P=0.0003）。
RRT 新发病例患者的发病率存在显著的社会经济和地域差异。最大的两个肾病中心的发病率最高，这可能部分归因于晚期糖尿病肾病的发病率较高以及针对虚弱、主要是老年患者的新治疗方案。
