The relationship between hemodialysis mortality and the Chinese medical insurance type
The relationship between hemodialysis mortality and the Chinese medical insurance type
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血液透析死亡率与医保类型的关系
DOI：
10.1080/0886022x.2019.1657893
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发表时间：
2019-01
期刊：
影响因子：
3
通讯作者：
Chen Jianghua
中科院分区：
文献类型：
--
作者：
Yao Xi;Chen Shaohua;Lei Wenhua;Shi Nan;Lin Weiqiang;Du Xiaoying;Zhang Ping;Chen Jianghua
摘要 目的：在中国，有两种主要的医疗保险模式：城镇基本医疗保险（UBMI）和新型合作医疗计划（NCMS）。本研究的目的是评估接受血液透析（HD）患者的医疗保险类型与其生存率的关系。方法：回顾性分析浙江省2010年1月至2014年12月开始HD的终末期肾病成年患者，随访至2015年12月31日。将接受HD超过3个月的患者根据不同医疗保险类型分为两组。分析了人口统计学、临床数据和临床结果。使用Kaplan-Meier法计算存活率。结果：226个血液透析单位共纳入UBMI患者6779例（59±16岁，男性4331例（63.9%））和新农合患者7177例（59±16岁，男性3778例（52.8%））。与UBMI组相比，NCMS患者高血压肾病、糖尿病、动静脉瘘的比例较少，贫血、低蛋白血症、钙磷代谢等问题较多。 UBMI组1年、3年、5年生存率分别为95.4%、84.4%、74.1%，NCMS组1年、3年、5年生存率分别为93.1%、79.7%、67.7%。与 UBMI 相比，NCMS 患者的全因死亡率更高 (p<<0.001)。在多变量Cox比例风险模型中，NCMS与较高的死亡率独立相关（AHR = 1.53；95% CI 1.38 ∼ 1.68）。结论：医疗保险模式与 HD 患者生存率独立相关，新农合与中国维持性血液透析患者死亡率增加相关。
Abstract Objectives: In China, there are two major medical insurance models: the Urban Basic Medical Insurance (UBMI) and the New Cooperative Medical Scheme (NCMS). The aim of the present study was to evaluate the association of the medical insurance type of patients undergoing hemodialysis (HD) with their survival. Methods: We retrospectively analyzed the end-stage renal disease adult patients initiating HD between January 2010 and December 2014 in Zhejiang province, followed up through 31 December 2015. Patients who had received HD for over 3 months were separated into two groups, based on different medical insurance type. Demographic, clinical data, and clinical outcomes were analyzed. The survival rates were calculated by using the Kaplan–Meier method. Results: A total of 6779 patients (59 ± 16 years old, 4331 males (63.9%)) with UBMI and 7177 (59 ± 16 years old, 3778 males (52.8%)) with NCMS enrolled from 226 hemodialysis units. Compared with UBMI group, patients with NCMS had a smaller percentage of hypertensive nephropathy, diabetes mellitus and arteriovenous fistula, faced with more problems in anemia, hypoalbuminemia and metabolism of calcium and phosphorous. The 1-, 3- and 5-year survival rates were 95.4, 84.4, and 74.1% in UBMI group, 93.1, 79.7, and 67.7% in NCMS group, respectively. Patients with NCMS showed higher all-cause mortality compared with UBMI (p < 0.001). In multivariate Cox proportional hazards model, NCMS was independently associated with higher mortality (AHR = 1.53; 95% CI 1.38 ∼ 1.68). Conclusions: The medical insurance model was independently associated with HD patient survival, NCMS was associated with increased mortality among patients undergoing maintenance hemodialysis in China.
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影响因子：
6.1
作者：
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通讯作者：
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