透析设施所有权与脏衰竭儿童的死亡风险之间的关联
Elaine Ku1,2, Charles E McCulloch2, Alexandra Bicki1
1Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco, San Francisco.
JAMA pediatrics
|September 5, 2023
概括
与非营利机构相比,在营利性机构接受透析的儿童面临的死亡风险更高. 这种增加的风险部分是由于获得移植的机会减少.
科学领域:
- 儿科脏病学 儿科脏病学
- 医疗保健服务研究 医疗服务研究
- 流行病学 流行病学
背景情况:
- 成年人的营利性透析设施与死亡率的增加有关.
- 了解儿童群体中这种关联对于改善护理至关重要.
研究的目的:
- 调查营利性透析设施状态与脏衰竭儿童的死亡风险之间的关联.
- 检查移植访问是否调解了这种关联.
主要方法:
- 使用美国脏数据系统记录 (2000-2019) 进行的回顾性队列研究.
- 对15359名开始透析的儿童进行分析.
- 使用细灰和考克斯回归模型分析了时间更新的利状况和竞争风险 (移植).
主要成果:
- 与非营利机构相比,营利机构的儿童死亡风险高出2.07倍 (95% CI,1.83-2.35) 与非营利机构相比.
- 当移植没有被审查时,这种风险仍然很高 (HR,1.47;95% CI,1.35-1.61).
- 在营利性机构减少移植机会,导致67%的死亡风险增加.
结论:
- 营利性透析设施的地位与患有功能衰竭的儿童的死亡率显著增加有关.
- 这些设施的移植机会较低是调解这种差异的关键因素.
- 需要有针对性的干预措施来解决差异,并改善儿科透析护理的结果.
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