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Variation in dialysis patient mortality by Health Authority
E O'Riordan1, D Lambe, D J O'Donoghue
1Hope Hospital, Salford Royal Hospital NHS Trust, Salford, UK.
QJM : Monthly Journal of the Association of Physicians
|September 23, 2003
Summary
Patient survival on maintenance dialysis therapy varies significantly by health authority. Socioeconomic factors of health authorities, such as urban or rural settings, impact long-term dialysis outcomes.
Area of Science:
- Nephrology
- Public Health
- Health Services Research
Background:
- Maintenance dialysis is a specialized, labor-intensive treatment typically provided at regional centers.
- The influence of a patient's health authority of residence on long-term dialysis outcomes remains unclear.
Purpose of the Study:
- To investigate survival patterns among patients initiating maintenance dialysis in Northwest England from 1990 to 1999.
- To determine if geographical and socioeconomic factors associated with health authorities affect dialysis patient survival.
Main Methods:
- Retrospective analysis of data from 10 dialysis centers serving 18 health authorities.
- Inclusion of patient demographics, dialysis modality, residence (postal code), and diabetic status.
- Utilized postal codes to calculate distance to dialysis centers and the Carstairs socioeconomic index.
Main Results:
- A total of 2458 patients were analyzed.
- Significant differences in survival on dialysis therapy were observed across different health authorities (p < 0.0001).
- Socioeconomic profiling of health authorities (ONS1 classification) revealed survival disparities, with patients from Urban and Rural areas experiencing longer survival than those from Mining/Industrial, Mature, or Prospering areas (p < 0.0001).
Conclusions:
- Health authority of residence is a significant determinant of survival for patients on maintenance dialysis.
- The interaction between centralized, specialized renal services and local health authorities may play a crucial role in patient outcomes.