NIHR Musculoskeletal Biomedical Research Unit, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Nephrol Dial Transplant. 2012 Apr;27(4):1598-607. doi: 10.1093/ndt/gfr466. Epub 2011 Aug 30.
Introduction. This study explores the geographical variation in renal replacement therapy (RRT) incidence and prevalence after adjusting for general population socio-demographics, renal unit treatment patterns and travel times.
The UK Renal Registry provided data on all patients in England commencing RRT in 2007 and receiving RRT on 31 December 2007. Multilevel Poisson regression models were constructed separately for incidence and prevalence. Geographical Information Systems software enabled estimation of road travel times and renal unit catchment areas. Small area estimates of RRT prevalence were produced for all 354 local authority districts.
Adjusted RRT incidence rates were 1.4 (95% confidence interval 1.2-1.6) times higher in the most deprived areas and 1.7 (1.5-2.0) and 1.5 (1.3-1.7) times higher in areas with most Black and South Asian inhabitants (10+%), respectively. The proportion of a centre's patients on haemodialysis or transplanted were positively associated with RRT incidence (not prevalence); numbers of satellite units were negatively associated with RRT incidence (not prevalence). While only 3% of patients lived >30 min from a dialysis unit, there was an effect of travel time on RRT rates; individuals living 45+ min from a dialysis unit were 20% less likely to commence or receive RRT than those living within 15 min (Ptrend=0.36 and Ptrend<0.001, respectively). A 4-fold variation in adjusted local authority district RRT prevalence rates could not be explained.
Expansion of renal unit facilities in England has reduced travel times in most areas though the possibility of inequitable geographic access to RRT persists.
本研究旨在调整一般人群的社会人口统计学、肾脏单位治疗模式和旅行时间后，探讨肾脏替代治疗（RRT）发生率和患病率的地域差异。
英国肾脏登记处提供了 2007 年在英格兰开始接受 RRT 并于 2007 年 12 月 31 日接受 RRT 的所有患者的数据。分别使用多水平泊松回归模型构建了发病率和患病率的模型。地理信息系统软件可估算道路旅行时间和肾脏单位的覆盖范围。为所有 354 个地方当局地区生成了 RRT 患病率的小区域估计值。
调整后的 RRT 发病率在最贫困地区高 1.4 倍（95%置信区间 1.2-1.6），在黑人及南亚裔（10%+）居民最多的地区高 1.7 倍（1.5-2.0）和 1.5 倍（1.3-1.7）。中心的血液透析或移植患者比例与 RRT 发病率呈正相关（与患病率无关）；卫星单位数量与 RRT 发病率呈负相关（与患病率无关）。尽管只有 3%的患者居住在离透析单位 30 分钟以上的地方，但旅行时间对 RRT 率仍有影响；与居住在 15 分钟内的患者相比，居住在透析单位 45 分钟以上的患者开始或接受 RRT 的可能性低 20%（趋势 P 值分别为 0.36 和 0.001）。调整后的地方当局地区 RRT 患病率的 4 倍差异无法解释。
尽管仍然存在 RRT 地理获得不公平的可能性，但英格兰肾脏单位设施的扩展已减少了大多数地区的旅行时间。
