Service de Néphrologie, Centre Hospitalier Public du Cotentin, rue du Val de Saire, Cherbourg, France.
Centre Universitaire des Maladies Rénales, CHU de Caen Avenue Côte de Nacre, Caen, France.
Perit Dial Int. 2022 Jul;42(4):361-369. doi: 10.1177/08968608211023268. Epub 2021 Jul 1.
Social deprivation could act as a barrier to peritoneal dialysis (PD). The objective of this study was to assess the association between social deprivation estimated by the European deprivation index (EDI) and PD uptake and to explore the potential mediators of this association.
From the Renal Epidemiology and Information Network registry, patients who started dialysis in 2017 were included. The EDI was calculated based on the patient's address. The event of interest was the proportion of PD 3 months after dialysis initiation. A mediation analysis with a counterfactual approach was carried out to evaluate the direct and indirect effect of the EDI on the proportion of PD.
Among the 9588 patients included, 1116 patients were on PD; 2894 (30.2%) patients belonged to the most deprived quintile (Q5). PD was associated with age >70 years (odds ratio (OR) 0.79 [95% confidence interval (CI): 0.69-0.91]), male gender (0.85 [95% CI: 0.74-0.97]), cardiovascular disease (OR 0.86 [95% CI: 0.86-1.00]), chronic heart failure (OR 1.34 [95% CI: 1.13-1.58]), active cancer (OR 0.67 [95% CI: 0.53-0.85]) and obesity (OR 0.75 [95% CI: 0.63-0.89]). In the mediation analysis, Q5 had a direct effect on PD proportion OR 0.84 [95% CI: 0.73-0.96]. The effect of Q5 on the proportion of PD was mediated by haemoglobin level at dialysis initiation (OR 0.96 [95% CI: 0.94-0.98]) and emergency start (OR 0.98 [95% CI: 0.96-0.99]).
Social deprivation, estimated by the EDI, was associated with a lower PD uptake. The effect of social deprivation was mediated by haemoglobin level, a proxy of predialysis care and emergency start.
社会剥夺可能成为腹膜透析（PD）的障碍。本研究旨在评估欧洲剥夺指数（EDI）估计的社会剥夺与 PD 使用率之间的关联，并探讨这种关联的潜在中介因素。
从肾脏流行病学和信息网络登记处中纳入了 2017 年开始透析的患者。根据患者的地址计算 EDI。感兴趣的事件是透析开始后 3 个月 PD 的比例。采用反事实方法进行中介分析，以评估 EDI 对 PD 比例的直接和间接影响。
在纳入的 9588 名患者中，有 1116 名患者接受 PD 治疗；2894 名（30.2%）患者属于最贫困五分位数（Q5）。PD 与年龄>70 岁（比值比（OR）0.79[95%置信区间（CI）：0.69-0.91]）、男性（0.85[95%CI：0.74-0.97]）、心血管疾病（OR 0.86[95%CI：0.86-1.00]）、慢性心力衰竭（OR 1.34[95%CI：1.13-1.58]）、活动性癌症（OR 0.67[95%CI：0.53-0.85]）和肥胖（OR 0.75[95%CI：0.63-0.89]）有关。在中介分析中，Q5 对 PD 比例的直接影响为 OR 0.84[95%CI：0.73-0.96]。Q5 对 PD 比例的影响通过透析开始时的血红蛋白水平（OR 0.96[95%CI：0.94-0.98]）和紧急开始（OR 0.98[95%CI：0.96-0.99]）来介导。
用 EDI 估计的社会剥夺与 PD 使用率较低有关。社会剥夺的影响通过血红蛋白水平（透析前护理和紧急开始的替代指标）来介导。
