Mortality among hemodialysis patients in Europe, Japan, and the United States:: Case-mix effects
Mortality among hemodialysis patients in Europe, Japan, and the United States:: Case-mix effects
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DOI：
10.1053/j.akjd.2004.08.006
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发表时间：
2004-11-01
影响因子：
13.2
通讯作者：
Levin, NW
中科院分区：
文献类型：
--
作者：
Goodkin, DA;Young, EW;Levin, NW
背景：透析结局和实践模式研究非常适合识别病例组合效应，因为其数据集广泛。该数据集被用来检查病例组合变量对死亡率的影响，以及这些变量在多大程度上解释了各地区死亡率的差异，以及B型肝炎和丙型肝炎的流行率和发病率。研究方法：从1996年至2002年，确定了8，615例患者的人口统计学和共病特征;记录了该队列的死亡率，加上置换患者（总数n = 16，720）。死亡率与年龄增加、非黑人、冠状动脉疾病、充血性心力衰竭、其他心脏病、糖尿病、外周血管疾病、脑血管疾病、无高血压、肺病、癌症、人类免疫缺陷病毒感染、胃肠道出血、神经系统疾病、精神疾病、蜂窝织炎/坏疽、丙型肝炎和吸烟相关。结果美国患者的年龄略大于欧洲或日本患者，糖尿病、冠状动脉疾病、充血性心力衰竭、外周血管疾病和脑血管疾病的患病率最高。结论：在调整病例组合以评估各设施的死亡率后，发现死亡率的区域差异（美国最高，日本最低）和国家内设施之间的差异在这种校正后仍然存在。实践模式可能是造成这种差异的部分原因。各机构的B型肝炎病毒（HBV）患病率随着每个机构透析患者数量的增加而增加;在使用治疗HBV感染患者方案的机构中，HBV血清转换的风险降低。更多的工作人员与至少2年的正规护理培训与较低的丙型肝炎病毒感染率和较低的血清转换风险。
Background: The Dialysis Outcomes and Practice Patterns Study is well suited to identify case-mix effects, given its extensive data set. The data set was used to examine the influence of case-mix variables on mortality and the extent to which these variables account for differences in mortality across regions, as well as the prevalence and incidence of hepatitis B and hepatitis C. Methods: Demographic and comorbid disease features were determined for 8,615 patients internationally; mortality was recorded for this cohort, plus replacement patients (total n = 16,720), from 1996 to 2002. Mortality was associated with increasing age, nonblack race, coronary artery disease, congestive heart failure, other cardiac disease, diabetes mellitus, peripheral vascular disease, cerebrovascular disease, absence of hypertension, lung disease, cancer, human immunodeficiency virus infection, gastrointestinal bleeding, neurologic disease, psychiatric disease, celluiltis/gangrene, hepatitis C, and smoking. Results US patients were slightly older than those in Europe or Japan and had the highest prevalence of diabetes, coronary artery disease, congestive heart failure, peripheral vascular disease, and cerebrovascular disease. Conclusion: Upon adjusting for case-mix to assess mortality across facilities, it was found that regional differences in mortality (highest in the United States and lowest in Japan) and differences across facilities within nations remain after such corrections. It is likely that practice patterns account for some of this variation. Prevalence of hepatitis B virus (HBV) across facilities increased as the number of dialyzing patients per facility increased; risk of HBV seroconversion decreased among facilities using protocols for treatment of patients with HBV infection. Greater employment of staff with at least 2 years of formal nursing training was associated with lower prevalence of hepatitis C virus infection and lower seroconversion risk.