Imanishi Yasuo, Fukuma Shingo, Karaboyas Angelo, Robinson Bruce M, Pisoni Ronald L, Nomura Takanobu, Akiba Takashi, Akizawa Tadao, Kurokawa Kiyoshi, Saito Akira, Fukuhara Shunichi, Inaba Masaaki
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
PLoS One. 2017 Mar 6;12(3):e0170731. doi: 10.1371/journal.pone.0170731. eCollection 2017.
Socioeconomic status (SES) factors such as employment, educational attainment, income, and marital status can affect the health and well-being of the general population and have been associated with the prevalence of chronic kidney disease (CKD). However, no studies to date in Japan have reported on the prognosis of patients with CKD with respect to SES. This study aimed to investigate the influences of employment and education level on mortality and hospitalization among maintenance hemodialysis (HD) patients in Japan.
Data on 7974 HD patients enrolled in Dialysis Outcomes and Practice Patterns Study phases 1-4 (1999-2011) in Japan were analysed. Employment status, education level, demographic data, and comorbidities were abstracted at entry into DOPPS from patient records. Mortality and hospitalization events were collected during follow-up. Patients on dialysis < 120 days at study entry were excluded from the analyses. Cox regression modelled the association between employment and both mortality and hospitalization among patients < 60 years old. The association between education and outcomes was also assessed. The association between patient characteristics and employment among patients < 60 years old was assessed using logistic regression.
During a median follow-up of 24.9 months (interquartile range, 18.4-32.0), 10% of patients died and 43% of patients had an inpatient hospitalization. Unemployment was associated with mortality (hazard ratio [HR] = 1.57; 95% confidence interval [CI]: 1.05-2.36) and hospitalization (HR = 1.25; 95% CI: 1.08-1.44). Compared to patients who graduated from university, patients with less than a high school (HS) education and patients who graduated HS with some college tended to have elevated mortality (HR = 1.41; 95% CI, 1.04-1.92 and HR = 1.36; 95% CI: 1.02-1.82, respectively) but were not at risk for increased hospitalizations. Factors associated with unemployment included lower level of education, older age, female gender, longer vintage, and several comorbidities.
Employment and education status were inversely associated with mortality in patients on maintenance HD in Japan. Employment but not education was also inversely associated with hospitalizations. After adjustment for comorbidities, the associations with clinical outcomes tended to be stronger for employment than education status.
社会经济地位（SES）因素，如就业、教育程度、收入和婚姻状况，会影响普通人群的健康和福祉，并与慢性肾脏病（CKD）的患病率相关。然而，日本迄今尚无研究报告CKD患者的SES预后情况。本研究旨在调查就业和教育水平对日本维持性血液透析（HD）患者死亡率和住院率的影响。
分析了日本透析结果与实践模式研究第1 - 4阶段（1999 - 2011年）纳入的7974例HD患者的数据。在患者进入DOPPS时，从患者记录中提取就业状况、教育水平、人口统计学数据和合并症信息。在随访期间收集死亡率和住院事件。研究开始时透析时间<120天的患者被排除在分析之外。Cox回归模型分析了60岁以下患者就业与死亡率和住院率之间的关联。还评估了教育与结局之间的关联。使用逻辑回归评估60岁以下患者的特征与就业之间的关联。
在中位随访24.9个月（四分位间距，18.4 - 32.0）期间，10%的患者死亡，43%的患者有住院治疗。失业与死亡率（风险比[HR]=1.57；95%置信区间[CI]：1.05 - 2.36）和住院率（HR = 1.25；95% CI：1.08 - 1.44）相关。与大学毕业的患者相比，高中（HS）以下学历和高中毕业且上过一些大学的患者死亡率往往升高（HR分别为1.41；95% CI，1.04 - 1.92和HR = 1.36；95% CI：1.02 - 1.82），但住院风险并未增加。与失业相关的因素包括较低的教育水平、年龄较大、女性、透析时间较长和多种合并症。
在日本，就业和教育状况与维持性HD患者的死亡率呈负相关。就业而非教育也与住院率呈负相关。在调整合并症后，就业与临床结局的关联往往比教育状况更强。
