卫生服务地理可达性对接受治疗的终末期肾病患者的影响：2000-2010 年队列研究。

Effects of health service geographic accessibility in patients with treated end stage kidney disease: Cohort study 2000-2010.

机构信息

The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.

Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia.

出版信息

Nephrology (Carlton). 2017 Dec;22(12):1008-1016. doi: 10.1111/nep.12913.

DOI:10.1111/nep.12913

PMID:27575384

Abstract

AIM

Patients in rural areas experience poor access to health services. There are limited data on patterns of health service utilization in rural patients treated with renal replacement therapy (RRT).

METHODS

All prevalent patients over the age of 18 and resident in New South Wales who were receiving RRT on 01/07/2000 and incident patients who started RRT between 01/07/2000 up until 31/07/2010 were included in the study. The Accessibility Remoteness Index of Australia was used to measure rurality and to categorize participant postcode of residence at the time of their first use of a New South Wales healthcare facility after the start of RRT. We assessed (1) rates of hospitalization, (2) rates of inter-hospital transfer (IHT), (3) length of hospital stay (LOS) and (4) survival. Day-only and dialysis admissions were excluded. Negative binomial regression was used to calculate incidence rate ratios (IRR) for hospitalizations, IHT and LOS. Cox proportional hazards was used to calculate hazard ratios (HR) for survival.

RESULTS

Of the 10 505 patients included in the analysis, 1527 (15%) were rural residents while 8978 (85%) resided in urban areas. Median follow up time from start of RRT/study to end of study/death was 4.2 years (IQR 2.0 to 8.2). After allowing for differences in baseline characteristics, rural residence increased the rates of hospitalization by 8% (IRR 1.08: 95% CI 1.01-1.15; P = 0.02), rates of IHT by 176% (IRR 2.76: 95% CI 2.44-3.13; P < 0.001) and the hazard of death by 14% (HR 1.14 95% CI: 1.05-1.24; P = 0.003) LOS was similar (Median 4.0; P = 0.07).

CONCLUSIONS

Rural residents receiving RRT have higher hospitalization rates, markedly higher rates of IHT and higher long-term mortality compared with their urban counterparts.

摘要

目的

农村地区的患者获得医疗服务的机会有限。在接受肾脏替代治疗（RRT）的农村患者中，关于卫生服务利用模式的数据有限。

方法

研究纳入了 2000 年 7 月 1 日及以后居住在新南威尔士州、年龄在 18 岁及以上且正在接受 RRT 的所有现患患者，以及 2000 年 7 月 1 日至 2010 年 7 月 31 日期间开始接受 RRT 的新发患者。本研究使用澳大利亚可达性偏远指数（Accessibility Remoteness Index of Australia）衡量农村地区的可达性，并将参与者在开始接受 RRT 后首次使用新南威尔士州医疗设施时的居住邮政编码归类。我们评估了（1）住院率、（2）医院间转院率（IHT）、（3）住院时间（LOS）和（4）生存率。排除日间和透析入院。采用负二项回归计算住院、IHT 和 LOS 的发病率比值（IRR）。采用 Cox 比例风险模型计算生存率的风险比（HR）。

结果

在纳入分析的 10505 名患者中，1527 名（15%）为农村居民，8978 名（85%）居住在城市地区。从开始接受 RRT/研究到研究结束/死亡的中位随访时间为 4.2 年（IQR 2.0-8.2）。在考虑了基线特征差异后，农村居民的住院率增加了 8%（IRR 1.08：95%CI 1.01-1.15；P=0.02），IHT 率增加了 176%（IRR 2.76：95%CI 2.44-3.13；P<0.001），死亡率的风险增加了 14%（HR 1.14：95%CI：1.05-1.24；P=0.003），而 LOS 无显著差异（中位数 4.0；P=0.07）。