Dataset Information

Mortality risk of chronic kidney disease: A comparison between the adult populations in urban China and the United States.

ABSTRACT:

Background

Chronic kidney disease (CKD) is a risk factor for all-cause mortality in the United States, but the evidence from China is limited. We investigate whether prognosis of CKD (mortality) differs between the two countries. In particular, we sought to compare the strength of association between CKD stage and all-cause mortality, by country.

Methods

Mortality-linked data from China National Survey of Chronic Kidney Disease (urban population, n = 25,269) and US NHANES (2005-2010, n = 15,209) for adults >20 years old were analyzed. The Chinese cohort was followed until Dec 31, 2013, while the NHANES cohort until Dec 31, 2011. CKD was defined by eGFR <60ml/min/1.73m2 or albuminuria (defined as ACR ?30mg/g). Weighted Cox models were used to evaluate the association between the two CKD indicators and mortality. Both stratified and combined models (with country interactions) were explored.

Results

The Chinese sample had a lower proportion of eGFR<60 ml/min/1.73m2 (3.7% vs. 6.9%) and albuminuria (7.6% vs. 9.0%), compared to the US. Higher rates of mortality were observed with higher stages of CKD in both countries. HRs for mortality in the more advanced CKD categories reached 2.18 (1.14-4.15) in China and 1.66 (1.18-2.32) in the US in the absence of albuminuria, and 2.30 (1.13-4.68) and 3.04 (2.33-3.96) in the presence of albuminuria. No significant interactions were detected between country and these categories.

Conclusion

The association between albuminuria and reduced eGFR and all-cause mortality was similar in both countries, with albuminuria being associated with the larger effect size compared to lower eGFR.

SUBMITTER: Wang J

PROVIDER: S-EPMC5854279 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Mortality risk of chronic kidney disease: A comparison between the adult populations in urban China and the United States.

Wang Jinwei J Wang Fang F Saran Rajiv R He Zhi Z Zhao Ming-Hui MH Li Yi Y Zhang Luxia L Bragg-Gresham Jennifer J

PloS one 20180315 3

<h4>Background</h4>Chronic kidney disease (CKD) is a risk factor for all-cause mortality in the United States, but the evidence from China is limited. We investigate whether prognosis of CKD (mortality) differs between the two countries. In particular, we sought to compare the strength of association between CKD stage and all-cause mortality, by country.<h4>Methods</h4>Mortality-linked data from China National Survey of Chronic Kidney Disease (urban population, n = 25,269) and US NHANES (2005-20 ...[more]

PMID: 29543826

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Project description:ImportancePatterns in emergency department (ED) use by rural populations may be an important indicator of the health care needs of individuals in the rural United States and may critically affect rural hospital finances.ObjectiveTo describe urban and rural differences in ED use over a 12-year period by demographic characteristics, payers, and characteristics of care, including trends in ambulatory care-sensitive conditions and ED safety-net status.Design, setting, and participantsThis cross-sectional study of ED visit data from the nationally representative National Hospital Ambulatory Medical Care Survey examined ED visit rates from January 2005 to December 2016. Visits were divided by urban and rural classification and stratified by age, sex, race/ethnicity, and payer. Emergency departments were categorized as urban or rural in accordance with the US Office of Management and Budget classification. Codes from the International Classification of Diseases, Ninth Revision (ICD-9), were used to extract visits related to ambulatory care-sensitive conditions. Safety-net status was determined by the Centers for Disease Control and Prevention definition. Visit rates were calculated using annual US Census Bureau estimates. National Hospital Ambulatory Medical Care Survey estimates were generated using provided survey weights and served as the numerator, yielding an annual, population-adjusted rate. Data were analyzed from June 2017 to November 2018.Main outcomes and measuresEmergency department visit rates for 2005 and 2016 with 95% confidence intervals, accompanying rate differences (RDs) comparing the 2 years, and annual rate change (RC) with accompanying trend tests using weighted linear regression models.ResultsDuring the period examined, rural ED visit estimates increased from 16.7 million to 28.4 million, and urban visits increased from 98.6 million to 117.2 million. Rural ED visits increased for non-Hispanic white patients (13.5 million to 22.5 million), Medicaid beneficiaries (4.4 million to 9.7 million), those aged 18 to 64 years (9.6 million to 16.7 million), and patients without insurance (2.7 million to 3.4 million). Rural ED visit rates increased by more than 50%, from 36.5 to 64.5 visits per 100 persons (RD, 28.9; RC, 2.2; 95% CI, 1.2 to 3.3), outpacing urban ED visit rates, which increased from 40.2 to 42.8 visits per 100 persons (RD, 2.6; RC, 0.2; 95% CI, -0.1 to 0.6). By 2016, nearly one-fifth of all ED visits occurred in the rural setting. From 2005 to 2016, rural ED utilization rates increased for non-Hispanic white patients (RD, 26.1; RC, 1.6; 95% CI, 0.4 to 2.8), Medicaid beneficiaries (RD, 56.4; RC, 4.1; 95% CI, 2.1 to 6.1), those aged 18 to 44 years (46.9 to 81.6 visits per 100 persons; RD, 34.7; RC, 2.3; 95% CI, 1.1 to 3.5) as well as those aged 45 to 64 years (27.5 to 53.9 visits per 100 persons; RD, 26.5; RC, 1.6; 95% CI, 0.7 to 2.5), and patients without insurance (44.0 to 66.6 visits per 100 persons per year; RD, 22.6; RC, 2.7; 95% CI, 0.2 to 5.2), with a larger proportion of rural EDs categorized as safety-net status.Conclusions and relevanceRural EDs are experiencing important changes in utilization rates, increasingly serving a larger proportion of traditionally disadvantaged groups and with greater pressure as safety-net hospitals.

Dataset Information

Mortality risk of chronic kidney disease: A comparison between the adult populations in urban China and the United States.

Background

Methods

Results

Conclusion

Publications

Mortality risk of chronic kidney disease: A comparison between the adult populations in urban China and the United States.

Similar Datasets

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