Department of Pediatrics, Peking University First Hospital, No.1 Xi An Men Da Jie, Beijing, 100034, People's Republic of China.
Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
Pediatr Nephrol. 2022 Nov;37(11):2705-2714. doi: 10.1007/s00467-022-05493-6. Epub 2022 Feb 28.
Whether medical insurance impacts the timely diagnosis in chronic kidney disease (CKD) children is unknown. We aim to examine the extent to which insurance is associated with access to timely diagnosis and different stages of CKD among a large population of children in China.
A retrospective, cross-sectional study based on China's national hospitalized record database was carried out. Children aged 0-17 years diagnosed as CKD stages 1-5 between June 1, 2013, and December 31, 2018, were included. A diagnosis of advanced CKD stage (CKD stage 4 or 5) was the primary outcome. Multivariable logistic regression model adjusted for age, sex, cross-regional hospitalization, year of diagnosis, and cause of CKD was used to assess the association between insurance status and the stage of CKD when diagnosed.
A total of 10,256 children (median [interquartile range, IQR] age, 12.4 [7.9, 15.4] years) were included. There were 4716 (46.0%) uninsured children in the included population. The insurance coverage was highest in children 13-17 years old (60.9%). The hospitalized charge was highest in stage 5 uninsured children (median [IQR], ¥13,000.89 [7640.63, 24,585.00]). More uninsured children are diagnosed in CKD stage 4 or 5 (48.1%) than insured children (47.5%). Uninsured children had higher odds (odds ratio [OR] 1.20, [95% CI, 1.08-1.32]) of receiving a diagnosis of CKD stage 4 or 5 compared with insured children.
Lack of medical insurance was associated with a more advanced stage of CKD when diagnosed in hospitalized children. A higher resolution version of the Graphical abstract is available as Supplementary information.
医疗保险是否会影响慢性肾脏病（CKD）患儿的及时诊断尚不清楚。我们旨在研究在中国大量儿童中，医疗保险与及时诊断以及 CKD 不同阶段的关系。
本研究基于中国国家住院记录数据库进行了一项回顾性、横断面研究。纳入 2013 年 6 月 1 日至 2018 年 12 月 31 日期间被诊断为 CKD 1-5 期的 0-17 岁儿童。晚期 CKD 阶段（CKD 4 或 5 期）的诊断为主要结局。采用多变量逻辑回归模型，根据年龄、性别、跨地区住院、诊断年份和 CKD 病因进行调整，评估保险状况与诊断时 CKD 阶段之间的关系。
共纳入 10256 名儿童（中位数[四分位距，IQR]年龄为 12.4[7.9，15.4]岁）。其中，有 4716 名（46.0%）儿童未参保。13-17 岁儿童的参保率最高（60.9%）。未参保的 CKD 5 期患儿住院费用最高（中位数[IQR]，¥13000.89[7640.63，24585.00]）。未参保儿童比参保儿童更易被诊断为 CKD 4 或 5 期（48.1%比 47.5%）。与参保儿童相比，未参保儿童被诊断为 CKD 4 或 5 期的可能性更高（比值比[OR]1.20[95%可信区间，1.08-1.32]）。
在住院患儿中，缺乏医疗保险与 CKD 诊断时更晚期的 CKD 有关。更清晰的图表可作为补充信息获取。
