Kolhe Nitin V, Fluck Richard J, Muirhead Andrew W, Taal Maarten W
Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom.
Department of Public Health, Derby City Council, Corporation Street, Derby, DE1 2FS, United Kingdom.
PLoS One. 2016 Oct 17;11(10):e0162856. doi: 10.1371/journal.pone.0162856. eCollection 2016.
The absence of effective interventions in presence of increasing national incidence and case-fatality in acute kidney injury requiring dialysis (AKI-D) warrants a study of regional variation to explore any potential for improvement. We therefore studied regional variation in the epidemiology of AKI-D in English National Health Service over a period of 15 years.
We analysed Hospital Episode Statistics data for all patients with a diagnosis of AKI-D, using ICD-10-CM codes, in English regions between 2000 and 2015 to study temporal changes in regional incidence and case-fatality.
Of 203,758,879 completed discharges between 1st April 2000 and 31st March 2015, we identified 54,252 patients who had AKI-D in the nine regions of England. The population incidence of AKI-D increased variably in all regions over 15 years; however, the regional variation decreased from 3·3-fold to 1·3-fold (p<0·01). In a multivariable adjusted model, using London as the reference, in the period of 2000-2005, the North East (odd ratio (OR) 1·38; 95%CI 1·01, 1·90), East Midlands (OR 1·38; 95%CI 1·01, 1·90) and West Midlands (OR 1·38; 95%CI 1·01, 1·90) had higher odds for death, while East of England had lower odds for death (OR 0·66; 95% CI 0·49, 0·90). The North East had higher OR in all three five-year periods as compared to the other eight regions. Adjusted case-fatality showed significant variability with temporary improvement in some regions but overall there was no significant improvement in any region over 15 years.
We observed considerable regional variation in the epidemiology of AKI-D that was not entirely attributable to variations in demographic or other identifiable clinical factors. These observations make a compelling case for further research to elucidate the reasons and identify interventions to reduce the incidence and case-fatality in all regions.
在急性肾损伤需透析（AKI-D）的全国发病率和病死率不断上升的情况下，缺乏有效的干预措施，因此有必要研究地区差异，以探索改进的可能性。因此，我们研究了15年间英国国民医疗服务体系中AKI-D流行病学的地区差异。
我们分析了2000年至2015年间英格兰各地区所有诊断为AKI-D患者的医院事件统计数据，使用ICD-10-CM编码来研究地区发病率和病死率的时间变化。
在2000年4月1日至2015年3月31日期间的203,758,879次出院中，我们在英格兰的九个地区确定了54,252例AKI-D患者。15年间，所有地区AKI-D的人群发病率均有不同程度的上升；然而，地区差异从3.3倍降至1.3倍（p<0.01）。在多变量调整模型中，以伦敦为参照，在2000 - 2005年期间，东北部（比值比（OR）1.38；95%置信区间1.01，1.90）、东米德兰兹（OR 1.38；95%置信区间1.01，1.90）和西米德兰兹（OR 1.38；95%置信区间1.01，1.90）的死亡几率较高，而英格兰东部的死亡几率较低（OR 0.66；95%置信区间0.49，0.90）。与其他八个地区相比，东北部在所有三个五年期间的OR均较高。调整后的病死率显示出显著差异，一些地区有暂时改善，但15年间所有地区总体上没有显著改善。
我们观察到AKI-D流行病学存在相当大的地区差异，这并不完全归因于人口统计学或其他可识别的临床因素的差异。这些观察结果有力地证明了需要进一步研究，以阐明原因并确定干预措施，以降低所有地区的发病率和病死率。
