Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: the impact of national health insurance
Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: the impact of national health insurance
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DOI：
10.1093/ndt/gfn406
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发表时间：
2008-12-01
影响因子：
6.1
通讯作者：
Hwang, Shang-Jyh
中科院分区：
文献类型：
--
作者：
Yang, Wu-Chang;Hwang, Shang-Jyh
背景自1995年全民健康保险实施后，台湾地区终末期肾脏疾病透析病患的发病率与盛行率迅速上升。本研究旨在探讨全民健康保险对台湾终末期肾病流行病学现况与趋势之影响。本研究采用回顾性队列分析的方法，收集台湾国家透析登记处的数据。从1990年到2001年，ESRD患者的I&P率分别从每百万人口126例增加到331例和382例增加到1322例，分别增加了2.6倍和3.46倍。中老年人和糖尿病肾病为原发性肾脏疾病的患者ESRD增加。I&P患者的平均年龄分别增加了7.2岁和7.1岁。所有这些参数都在1995年，即全民健康保险实施的那一年显著增加。1994年，第一年死亡率降至7.8/1000患者-月，2001年增至18.0/1000患者-月。1990-1994年队列中老年亚组（年龄> 65岁）的累积生存率高于1995-1999年队列。这些数据表明，全民健康保险的实施显着影响的流入和终末期肾病患者的死亡率。除了介绍台湾的ESRD流行病学，这项研究表明，全民健康保险的实施刺激治疗ESRD人口的增长。针对慢性肾脏疾病的预防计划对于减少ESRD患者数量的增长和随之而来的经济负担至关重要。
Background. Incident and prevalent (I&P) rates in dialysis end-stage renal disease (ESRD) patients in Taiwan increased rapidly following the launch of National Health Insurance (NHI) in 1995. Our aim was to explore the impact of NHI on the status and trends of ESRD epidemiology in Taiwan.Methods. This study was conducted using retrospective cohort analysis of data collected from the Taiwan national dialysis registry.Results. From 1990 to 2001, I&P rates of ESRD patients increased 2.6 times from 126 to 331 per million populations (pmp) and 3.46 times from 382 to 1322 pmp, respectively. Increasing ESRD was seen in patients who were middle-aged, elderly and who had diabetic nephropathy as their primary renal disease. The mean age of I&P patients increased by 7.2 years and 7.1 years, respectively. All of these parameters increased markedly in 1995, the year of NHI implementation. First-year mortality decreased to 7.8 per 1000 patient-months in 1994, and then increased to 18.0 in 2001. The cumulative survival rate of the elderly subgroup (age > 65) in the incident 1990-1994 cohort was greater than in the 1995-1999 cohort. These data indicated that NHI implementation significantly influenced the inflow and the mortality of ESRD patients.Conclusion. In addition to presenting ESRD epidemiology in Taiwan, this study demonstrated that NHI implementation stimulated the growth of treated ESRD populations. Preventive plans mounted against chronic kidney diseases will be essential to reduce the growth of ESRD patient numbers and consequent economic burdens.