米国における腹腔内透析利用の腎疾患状態および末期ネットワーク決定因子:多層ベータ回帰分析
George Miller1,2, Ahmad Alkhatib1
1School of Public Health, Imperial College London, London, UK.
まとめ
腹腔内透析 (PD) の使用はわずかに増加したが,依然として低い. 測定されていない状態と末期腎疾患 (ESRD) ネットワークの要因は,PDの利用に大きく影響し,地域政策分析の必要性を強調しています.
科学分野:
- 腎臓科と公衆衛生
- 医療サービス研究
- 健康政策の分析
背景:
- 慢性腎臓病 (CKD) と末期腎臓病 (ESRD) は,米国保健医療システムに重大な負担を課しています.
- 腸内透析 (PD) は費用対効果と患者の自律性などの利点にもかかわらず,全国的に著しく不足しています.
- 現存する研究では,患者レベルの要因とPDの採用に対するより広範な地域的な影響が完全に区別されていません.
研究 の 目的:
- 州レベルとESRDネットワークレベルの変動が米国全体のPD利用に及ぼす影響を調査する.
- PD利用に関連する要因を特定し,測定されていない状態とネットワーク効果の貢献を定量化します.
- 州とネットワークの調整されたランキングをPD利用パフォーマンスに基づいて提供します.
主な方法:
- 米国腎臓データシステム (USRDS),CMS,米国国勢調査局を含む2015年から2020年にかけての公的に利用可能なデータの分析.
- 州レベルの予測値を評価し,州とESRDネットワークの変動を考慮するために,多層ベータ回帰モデルを適用する.
- ランク付けされたランダム効果と2020年のPD率を比較して,地域的なアウトバイヤー値を特定する.
主要な成果:
- PD利用率は2015年から2020年の間に9.6%から12.8%に増加しました.
- 患者の人口統計 (性別,年齢,人種) と透析施設の密度はPD率に有意な影響を及ぼさなかったが,人口密度は負の関連を示した.
- 測定されていない状態 (ICC=0.47) とESRDネットワーク (ICC=0.53) の要因は,PD利用の変動の大部分を説明しました.
結論:
- 測定可能な人口統計的,提供者,地理的要因はPD利用の変数に占める割合は18.5%に過ぎなかった.
- PD利用の説明できない変動の約半分は州レベルの要因,残りの半分はESRDネットワークレベルの要因に起因する.
- 効果的な地域政策の特定と分析は,PDの採用を最適化するために不可欠です.
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