ANALYZING HOSPITALIZATION AND MORTALITY IN ESRD PATIENTS

据估计，超过230，000名美国人患有终末期肾病。 疾病（ESRD）。与终末期肾病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。 一个传统的焦点 肾脏学文献一直在比较 ESRD患者人群的不同亚组。最近的趋势 这表明，死亡前结果的研究可能会更多， 有用的. 迄今为止的分析主要是描述性的（例如表格）， 并比较不同亚组的发病率特征， ESRD患者人群。使用发病率作为结果显然是不合理的。 合理的;合理的预期是， 发病率水平也会降低死亡率， 提高生活质量的好处，直接相关的东西， 对于ESRD患者来说， 有必要制定和采用更复杂的方法， 分析当前ESRD的发病率和死亡率模式 患者人群。这些分析的结果可用于建议 各种ESRD亚群的治疗顺序，并可能确定 新的治疗方法应该针对的共病因素; 有可能降低与ESRD相关的发病率和死亡率。 因此，这项建议有两个主要目的。第一个涉及到一个 深入调查使用住院模式作为 死亡率的替代结局指标。决定专注于 住院是由于其与死亡率的强相关性（因此 作为死亡率的可能预测标志物），及其潜在的 作为患者发病率的纵向信息描述。的 第二个目标，是朝着实现 第一，涉及开发更复杂的方法， 分析这两种结果。具体而言，其目的是发展 方法，能够（i）有效地评估住院作为一个 死亡率的标志;（ii）使用纵向 结果，如住院治疗;（iii）改善目前的分析 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.