Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , Zhejiang Province , China.
Key Laboratory of Nephropathy, Key Laboratory of Kidney Disease Prevention and Control Technology , Hangzhou , Zhejiang Province , China.
Ren Fail. 2019 Nov;41(1):742-749. doi: 10.1080/0886022X.2019.1652648.
In China, there are two major medical insurance models: the Urban Basic Medical Insurance (UBMI) and the New Cooperative Medical Scheme (NCMS). The aim of the present study was to evaluate the association of the medical insurance type of patients undergoing hemodialysis (HD) with their survival. We retrospectively analyzed the end-stage renal disease adult patients initiating HD between January 2010 and December 2014 in Zhejiang province, followed up through 31 December 2015. Patients who had received HD for over 3 months were separated into two groups, based on different medical insurance type. Demographic, clinical data, and clinical outcomes were analyzed. The survival rates were calculated by using the Kaplan-Meier method. A total of 6779 patients (59 ± 16 years old, 4331 males (63.9%)) with UBMI and 7177 (59 ± 16 years old, 3778 males (52.8%)) with NCMS enrolled from 226 hemodialysis units. Compared with UBMI group, patients with NCMS had a smaller percentage of hypertensive nephropathy, diabetes mellitus and arteriovenous fistula, faced with more problems in anemia, hypoalbuminemia and metabolism of calcium and phosphorous. The 1-, 3- and 5-year survival rates were 95.4%, 84.4%, and 74.1% in UBMI group, 93.1%, 79.7%, and 67.7% in NCMS group, respectively. Patients with NCMS showed higher all-cause mortality compared with UBMI ( < .001). In multivariate Cox proportional hazards model, NCMS was independently associated with higher mortality (AHR = 1.53; 95% CI 1.38 ∼ 1.68). The medical insurance model was independently associated with HD patient survival, NCMS was associated with increased mortality among patients undergoing maintenance hemodialysis in China.
在中国，有两种主要的医疗保险模式：城镇基本医疗保险（UBMI）和新型农村合作医疗制度（NCMS）。本研究旨在评估接受血液透析（HD）治疗的患者的医疗保险类型与生存的关系。
我们回顾性分析了 2010 年 1 月至 2014 年 12 月期间在浙江省开始接受 HD 治疗的成年终末期肾病患者，随访至 2015 年 12 月 31 日。根据不同的医疗保险类型，将接受 HD 治疗超过 3 个月的患者分为两组。分析人口统计学、临床数据和临床结局。采用 Kaplan-Meier 法计算生存率。
共纳入 6779 例 UBMI 患者（59±16 岁，4331 例男性[63.9%]）和 7177 例 NCMS 患者（59±16 岁，3778 例男性[52.8%]），分别来自 226 个血液透析单位。与 UBMI 组相比，NCMS 组高血压肾病、糖尿病和动静脉瘘的比例较小，贫血、低蛋白血症和钙磷代谢方面的问题较多。UBMI 组的 1、3 和 5 年生存率分别为 95.4%、84.4%和 74.1%，NCMS 组分别为 93.1%、79.7%和 67.7%。NCMS 组全因死亡率高于 UBMI 组（ < .001）。多因素 Cox 比例风险模型显示，NCMS 与死亡率升高独立相关（AHR=1.53；95%CI 1.38~1.68）。
医疗保险模式与 HD 患者的生存独立相关，NCMS 与中国维持性血液透析患者的死亡率增加相关。
