Feng Xue Snow, Farej Ryan, Dean Bonnie B, Xia Fang, Gaiser Andrew, Kong Sheldon X, Elliott Jay, Lindemann Stefanie, Singh Rakesh
Bayer US LLC, Whippany, New Jersey.
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
Kidney Med. 2021 Nov 3;4(1):100385. doi: 10.1016/j.xkme.2021.09.003. eCollection 2022 Jan.
RATIONALE & OBJECTIVE: Regional variation in chronic kidney disease (CKD) prevalence in patients with or without type 2 diabetes mellitus (T2DM) has not been well characterized.
Spatial and temporal comparative analysis.
SETTING & PARTICIPANTS: MarketScan databases were used to identify patients with CKD overall and subgroups of patients with CKD with and without T2DM in the United States.
Spatial patterns in CKD prevalence based on year, regional clusters of CKD between years, and characteristics of patients in high-prevalence states.
Geomapping was used to visualize the state-level data of CKD prevalence generated from 2013 to 2018. We used univariate local indicators of spatial association (LISA) to evaluate geographic differences in prevalence, differential LISA for changes in CKD prevalence over time, and the χ test to identify patient characteristics in the top-20th percentile states for the prevalence of CKD.
In univariate LISA, low-low clusters, in which a state has a low CKD prevalence and the surrounding states have a below-average CKD prevalence, were observed in the northwest region throughout the study period, regardless of the T2DM status, indicating a consistently low prevalence of CKD clustered in these areas. High-high clusters were observed, regardless of the T2DM status, in the southeast region in more recent years, suggesting an increased CKD prevalence in this region.
Health care insurance enrollment might not have been representative of the United States; the estimates were based on claims data that likely underestimated the true prevalence.
Geographic disparities in CKD prevalence appear increasingly magnified, with an increase in the southeastern region of the United States. This increase is especially problematic because patients with CKD in high-prevalence states experience a greater likelihood of chronic conditions than those in the rest of the United States.
2型糖尿病（T2DM）患者和非T2DM患者中慢性肾脏病（CKD）患病率的地区差异尚未得到充分描述。
时空比较分析。
利用MarketScan数据库识别美国CKD患者总体以及合并和不合并T2DM的CKD患者亚组。
基于年份的CKD患病率空间模式、各年份间CKD的地区聚集情况以及高患病率州患者的特征。
采用地理映射来可视化2013年至2018年生成的CKD患病率的州级数据。我们使用单变量空间关联局部指标（LISA）来评估患病率的地理差异、CKD患病率随时间变化的差异LISA，并使用χ检验来识别CKD患病率处于前20%州的患者特征。
在单变量LISA中，无论T2DM状态如何，在整个研究期间，西北地区均观察到低-低聚集，即一个州的CKD患病率低且周边州的CKD患病率低于平均水平，这表明这些地区CKD患病率一直较低。近年来，无论T2DM状态如何，在东南部地区均观察到高-高聚集，这表明该地区CKD患病率有所上升。
医疗保险参保情况可能不代表美国；估计基于索赔数据，可能低估了真实患病率。
CKD患病率的地理差异似乎越来越大，在美国东南部地区有所增加。这种增加尤其成问题，因为高患病率州的CKD患者比美国其他地区的患者患慢性病的可能性更大。
