Evaluation of Racial, Ethnic, and Socioeconomic Disparities in Initiation of Kidney Failure Treatment During the First 4 Months of the COVID-19 Pandemic.
Evaluation of Racial, Ethnic, and Socioeconomic Disparities in Initiation of Kidney Failure Treatment During the First 4 Months of the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2021.27369
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发表时间：
2021-10-01
影响因子：
13.8
通讯作者：
Trivedi AN
中科院分区：
文献类型：
--
作者：
Nguyen KH;Thorsness R;Hayes S;Kim D;Mehrotra R;Swaminathan S;Baranwal N;Lee Y;Rivera-Hernandez M;Trivedi AN
在新冠疫情早期，开始接受新发肾衰竭治疗的患者数量和特征发生了怎样的变化，这些变化是否与种族、族裔或社会经济地位有关？
在这项针对127149名在疫情前4个月（2020年3月1日至6月30日）新发肾衰竭的美国成年人的横断面研究中，开始接受新发肾衰竭治疗的患者数量下降了30%，与前几年相比，黑人患者以及居住在新冠死亡率高的县的患者开始治疗时的肾功能水平明显更差。
这些结果表明，新发肾衰竭患者数量的下降可能意味着疫情期间治疗开始时间延迟或医疗服务提供方式发生了变化。
这项横断面研究调查了在新冠疫情前4个月，不同种族、族裔和社会经济群体中开始接受新发肾衰竭治疗的美国成年人的数量。
肾衰竭患者需要治疗（即透析或移植）才能生存。新冠疫情的负担以及与疫情相关的医疗服务中断对少数种族和族裔以及社会弱势群体产生了不成比例的影响，这凸显了了解疫情期间肾衰竭治疗开始方面差异的重要性。
为了按种族和族裔、县级新冠死亡率以及社区层面的社会不利因素来研究新冠疫情后开始接受新发肾衰竭治疗的患者数量和人口统计学特征的变化。
这项横断面时间趋势研究使用了2018年1月1日至2020年6月30日期间美国肾衰竭患者的数据。数据分析于2021年1月至7月进行。
新冠疫情。
开始接受新发肾衰竭治疗的患者数量以及治疗开始时的平均估算肾小球滤过率（eGFR）。
研究人群包括2018年1月1日至2020年6月30日期间127149名新发肾衰竭患者（平均[标准差]年龄为62.8[15.3]岁；53021[41.7%]为女性，32932[25.9%]为非西班牙裔黑人，19835[15.6%]为西班牙裔/拉丁裔患者）。与新冠疫情前相比，在疫情的前4个月（即2020年3月1日至6月30日），接受预防性移植的新发肾衰竭患者比例显著下降（新冠疫情前为1805[2.1%]，疫情期间为551[1.4%]；P <.001），以动静脉内瘘开始血液透析治疗的患者比例也显著下降（新冠疫情前为2430[15.8%]，疫情期间为914[13.4%]；P <.001）。疫情期间治疗开始时的平均（标准差）eGFR从9.6（5.0）毫升/分钟/1.73平方米下降到9.5（4.9）毫升/分钟/1.73平方米（P <.001）。按种族/族裔进行分层分析时，这些下降仅在非西班牙裔黑人患者中观察到（平均[标准差]eGFR：新冠疫情前为8.4（4.6）毫升/分钟/1.73平方米，疫情期间为8.1（4.5）毫升/分钟/1.73平方米；P <.001）。居住在新冠死亡率最高的五分之一县的患者治疗开始时的eGFR显著下降（新冠疫情前为9.5（5.0）毫升/分钟/1.73平方米，疫情期间为9.2（5.0）毫升/分钟/1.73平方米；P <.001），但居住在其他县的患者则没有。2020年4月开始接受新发肾衰竭治疗的患者数量比预计的大约低30%。
在这项针对美国成年人的横断面研究中，新冠疫情与前4个月开始接受新发肾衰竭治疗的患者数量大幅减少以及在较低肾功能水平下开始治疗有关，特别是对于黑人患者以及居住在新冠死亡率高的县的人群。
How did the volume and characteristics of patients initiating treatment for incident kidney failure change early in the COVID-19 pandemic, and were these changes associated with race, ethnicity, or socioeconomic status? In this cross-sectional study of 127 149 US adults with incident kidney failure during the first 4 months of the pandemic (March 1 through June 30, 2020), the number of patients initiating treatment for incident kidney failure declined by 30%, with Black patients and patients living in counties with high COVID-19 mortality initiating treatment with significantly worse levels of kidney function when compared with prior years. These results suggest that declines in the number of patients with incident kidney failure may indicate delayed treatment initiation or changes in care delivery during the pandemic. This cross-sectional study examines the volume of US adults initiating treatment for incident kidney failure across racial, ethnic, and socioeconomic groups during the first 4 months of the COVID-19 pandemic. Persons with kidney failure require treatment (ie, dialysis or transplantation) for survival. The burden of the COVID-19 pandemic and pandemic-related disruptions in care have disproportionately affected racial and ethnic minority and socially disadvantaged populations, raising the importance of understanding disparities in treatment initiation for kidney failure during the pandemic. To examine changes in the number and demographic characteristics of patients initiating treatment for incident kidney failure following the COVID-19 pandemic by race and ethnicity, county-level COVID-19 mortality rate, and neighborhood-level social disadvantage. This cross-sectional time-trend study used data from US patients who developed kidney failure between January 1, 2018, and June 30, 2020. Data were analyzed between January and July 2021. COVID-19 pandemic. Number of patients initiating treatment for incident kidney failure and mean estimated glomerular filtration rate (eGFR) at treatment initiation. The study population included 127 149 patients with incident kidney failure between January 1, 2018, and June 30, 2020 (mean [SD] age, 62.8 [15.3] years; 53 021 [41.7%] female, 32 932 [25.9%] non-Hispanic Black, and 19 835 [15.6%] Hispanic/Latino patients). Compared with the pre–COVID-19 period, in the first 4 months of the pandemic (ie, March 1 through June 30, 2020), there were significant decreases in the proportion of patients with incident kidney failure receiving preemptive transplantation (1805 [2.1%] pre–COVID-19 vs 551 [1.4%] during COVID-19; P < .001) and initiating hemodialysis treatment with an arteriovenous fistula (2430 [15.8%] pre–COVID-19 vs 914 [13.4%] during COVID-19; P < .001). The mean (SD) eGFR at initiation declined from 9.6 (5.0) mL/min/1.73 m2 to 9.5 (4.9) mL/min/1.73 m2 during the pandemic (P < .001). In stratified analyses by race/ethnicity, these declines were exclusively observed among non-Hispanic Black patients (mean [SD] eGFR: 8.4 [4.6] mL/min/1.73 m2 pre–COVID-19 vs 8.1 [4.5] mL/min/1.73 m2 during COVID-19; P < .001). There were significant declines in eGFR at initiation for patients residing in counties in the highest quintile of COVID-19 mortality rates (9.5 [5.0] mL/min/1.73 m2 pre–COVID-19 vs 9.2 [5.0] mL/min/1.73 m2 during COVID-19; P < .001), but not for patients residing in other counties. The number of patients initiating treatment for incident kidney failure was approximately 30% lower than projected in April 2020. In this cross-sectional study of US adults, the COVID-19 pandemic was associated with a substantially lower number of patients initiating treatment for incident kidney failure and treatment initiation at lower levels of kidney function during the first 4 months, particularly for Black patients and people living in counties with high COVID-19 mortality rates.
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DOI：
10.1001/jamahealthforum.2020.1463
发表时间：
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期刊：
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影响因子：
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期刊：
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影响因子：
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