美国腹腔透析利用的病状况和末期病网络决定因素:多级别β回归分析
George Miller1,2, Ahmad Alkhatib1
1School of Public Health, Imperial College London, London, UK.
概括
腹腔透析 (PD) 的使用量略有增加,但仍然很低. 尚未测量的国家和末期脏病 (ESRD) 网络因素显著影响PD利用率,强调需要区域政策分析.
科学领域:
- 科和公共卫生
- 医疗服务研究
- 卫生政策分析
背景情况:
- 慢性病 (CKD) 和末期病 (ESRD) 对美国医疗保健系统造成了巨大的负担.
- 尽管腹腔透析具有成本效益和患者自主性等优点,但在全国范围内仍未得到充分利用.
- 目前的研究还没有完全区分患者层面的因素与更广泛的区域影响.
研究的目的:
- 调查州级和ESRD网络级差异对美国PD利用的影响.
- 确定与PD利用相关的因素,并量化未测量的状态和网络效应的贡献.
- 根据PD利用表现提供州和网络的调整排名.
主要方法:
- 分析2015-2020年公开可用的数据,包括美国脏数据系统 (USRDS),CMS和美国人口普查局.
- 应用多级Beta回归模型来评估国家级预测因素,并考虑国家和ESRD网络的变化.
- 排序随机效应与2020年的PD率进行比较,以确定区域性异常值.
主要成果:
- 在2015年至2020年期间,PD利用率从9.6%增加到12.8%.
- 患者人口统计 (性别,年龄,种族) 和透析设施密度没有显著影响PD率;人口密度显示出负相关性.
- 不测量状态 (ICC=0.47) 和ESRD网络 (ICC=0.53) 的因素解释了PD利用率的显著变化.
结论:
- 可测量的人口,提供者和地理因素仅占PD利用率的18.5%.
- 大约一半的PD利用率无法解释的变化归因于州级因素,另一半归因于ESRD网络级因素.
- 鉴定和分析高效和低效国家/网络的有效区域政策对于优化PD采用至关重要.
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