ANALYZING HOSPITALIZATION AND MORTALITY IN ESRD PATIENTS

据估计，超过23万美国人患有终末期肾脏 疾病(ESRD)。与ESRD相关的发病率和死亡率是主要的 公共卫生问题，必须加以解决。传统的关注点是 肾脏病的文献一直是基于死亡率的比较 终末期肾病患者群体的不同亚群。更近期的趋势 表明对死亡前结果的研究可能会更多 很有用。迄今为止的分析主要是描述性的(如表格)， 并比较不同亚组的发病率特征 终末期肾病患者群体。使用发病率作为一种结果显然是 明智的；有理由期待一种治疗方法能减少 发病率水平也应该会降低死亡率，并增加了 提高生活质量的好处，一些直接相关的和 对终末期肾病患者很重要。 有必要开发和采用更复杂的方法来 分析当前ESRD的发病率和死亡率模式 病人群体。这种分析的结果可以用来推荐 不同ESRD亚群的治疗序列，并可能识别 设计新的治疗方法应解决的共生因素；两者 有可能降低与终末期肾病相关的发病率和死亡率。 因此，这项建议有两个主要目标。第一个涉及一个 深入调查住院模式的使用情况 死亡率的替代结果衡量标准。决定把重点放在 住院是因为它与死亡率有很强的相关性(因此 可作为死亡率的可能预测标记)，以及它的潜力 作为对患者发病率的纵向信息性描述。这个 第二个目标是朝着实现以下目标方向迈出的必要步骤 首先，涉及到开发更复杂的方法来 分析这两种结果。具体地说，其目的是开发 能够(I)有效地评估住院情况的方法 死亡率的标记物；(2)使用纵向 结果，如住院；和，(3)改进目前的分析 以死亡率作为结果。

It is estimated that more than 230,000 Americans have end-stage renal disease (ESRD). The morbidity and mortality associated with ESRD are major public health problems, and must be addressed. A traditional focus of the nephrology literature has been on mortality-based comparisons between various subgroups of the ESRD patient population. More recent trends suggest that the study of pre-mortality outcomes may potentially be more useful. Analyses to date have primarily been descriptive (e.g. tabular), and compare characterizations of morbidity experienced across subgroups of the ESRD patient population. The use of morbidity as an outcome is clearly sensible; it is reasonable to expect that a therapy resulting in reduced levels of morbidity should also decrease mortality, and has the added benefit of improving quality of life, something directly relevant and important to ESRD patients. There is a need to develop and employ more sophisticated methodology for analyzing the morbidity and mortality patterns within the current ESRD patient population. The results of such analyses may be used to recommend treatment sequences for various ESRD subpopulations, and perhaps identify comorbid factors that new treatments should be designed to address; both have the potential to reduce morbidity and mortality associated with ESRD. Therefore, this proposal has two major objectives. The first involves an in-depth investigation into the use of hospitalization patterns as an alternative outcome measure to mortality. The decision to focus on hospitalization is due to its strong correlation with mortality (thus serving as a possible predictive marker for mortality), and its potential as a longitudinally informative description of patient morbidity. The second objective, a necessary step in the direction towards achieving the first, involves the development of more sophisticated methods for analyzing both outcomes. Specifically, the intent is to develop methodology that is able to (i) effectively evaluate hospitalization as a marker for mortality; (ii) model morbidity processes using longitudinal outcomes like hospitalization; and, (iii) improve upon current analyses using mortality as the outcome.