在英格兰,脏替代疗法模式和死亡率之间的健康差异:使用英国脏注册表数据的多州模型
Jessica Potts1, Camille M Pearse1,2, Mark Lambie1
1School of Medicine, Keele University, Keele, United Kingdom.
PLoS medicine
|February 18, 2026
概括
在置疗法 (KRT) 过渡和死亡率方面,种族和贫困差异仍然存在. 亚裔和黑人患者以及贫困地区的患者在KRT途径中面临更糟糕的结果,突出显著的健康不平等.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 众所周知,在置换疗法 (KRT) 启动方面存在种族和社会经济差异.
- 然而,它们对KRT模式转换和衰竭期间死亡率的影响不太清楚.
研究的目的:
- 调查种族和区域级贫困与KRT模式转型和死亡率之间的关联.
- 分析这些关联在KRT的患者生命过程中.
主要方法:
- 利用英国脏注册局对93,451名开始KRT的患者的数据 (2005-2020年).
- 采用参数多态模型 (韦布尔比例危险) 来估计腹腔透析 (PD),家庭血液透析 (HHD),中心血液透析 (ICHD),移植和死亡之间的过渡率.
- 包括种族和多重贫困指数 (IMD) 五分位数作为主要共变量,以年龄,性别和初级病 (糖尿病) 进行调整.
主要成果:
- 与白人患者相比,亚洲患者的ICHD到PD和PD到ICHD过渡率较低,移植后ICHD回归率较高.
- 黑人患者呈现较低的ICHD到PD和ICHD到HHD率,但更高的PD到ICHD和移植到ICHD过渡率.
- 与最贫困地区的患者相比,在PD,HHD和移植的过渡率较低,在ICHD移植和死亡率较高,与最贫困地区的患者相比.
结论:
- 调查结果显示,在整个KRT路径中存在持续的不平等现象.
- 多州建模方法为开发干预措施提供了一个框架,以提高护理中的公平性和患者结果.
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