Exploring the association between macroeconomic indicators and dialysis mortality

Anneke Kramer, Vianda S. Stel, Fergus J. Caskey, Benedicte Stengel, Robert F. Elliott, Adrian Covic, Claudia Geue, Ana Cusumano, Alison M. Macleod, Kitty J. Jager

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background and objectives Mortality on dialysis varies greatly worldwide, with patient-level factors explaining only a small part of this variation. The aim of this study was to examine the association of national-level macroeconomic indicators with the mortality of incident dialysis populations and explore potential explanations through renal service indicators, incidence of dialysis, and characteristics of the dialysis population.

Design, setting, participants, & measurements Aggregated unadjusted survival probabilities were obtained from 22 renal registries worldwide for patients starting dialysis in 2003–2005. General population age and health, macroeconomic indices, and renal service organization data were collected from secondary sources and questionnaires. Linear modeling with log–log transformation of the outcome variable was applied to establish factors associated with survival on dialysis.

Results Two-year survival on dialysis ranged from 62.3% in Iceland to 89.8% in Romania. A higher gross domestic product per capita (hazard ratio=1.02 per 1000 US dollar increase), a higher percentage of gross domestic product spent on healthcare (1.10 per percent increase), and a higher intrinsic mortality of the dialysis population (i.e., general population-derived mortality risk of the dialysis population in that country standardized for age and sex; hazard ratio=1.04 per death per 10,000 person years) were associated with a higher mortality of the dialysis population. The incidence of dialysis and renal service indicators were not associated with mortality on dialysis.

Conclusions Macroeconomic factors and the intrinsic mortality of the dialysis population are associated with international differences in the mortality on dialysis. Renal service organizational factors and incidence of dialysis seem less important.
Original languageEnglish
Pages (from-to)1655-1663
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume7
Issue number10
Early online date1 Jul 2012
DOIs
Publication statusPublished - 5 Oct 2012

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Dialysis
Mortality
Population
Gross Domestic Product
Kidney
Survival
Incidence
Iceland
Romania
Population Characteristics
Registries
Renal Dialysis
Economics
Organizations
Delivery of Health Care

Cite this

Kramer, A., Stel, V. S., Caskey, F. J., Stengel, B., Elliott, R. F., Covic, A., ... Jager, K. J. (2012). Exploring the association between macroeconomic indicators and dialysis mortality. Clinical Journal of the American Society of Nephrology, 7(10), 1655-1663. https://doi.org/10.2215/cjn.10461011

Exploring the association between macroeconomic indicators and dialysis mortality. / Kramer, Anneke; Stel, Vianda S.; Caskey, Fergus J.; Stengel, Benedicte; Elliott, Robert F.; Covic, Adrian; Geue, Claudia; Cusumano, Ana; Macleod, Alison M.; Jager, Kitty J.

In: Clinical Journal of the American Society of Nephrology, Vol. 7, No. 10, 05.10.2012, p. 1655-1663.

Research output: Contribution to journalArticle

Kramer, A, Stel, VS, Caskey, FJ, Stengel, B, Elliott, RF, Covic, A, Geue, C, Cusumano, A, Macleod, AM & Jager, KJ 2012, 'Exploring the association between macroeconomic indicators and dialysis mortality', Clinical Journal of the American Society of Nephrology, vol. 7, no. 10, pp. 1655-1663. https://doi.org/10.2215/cjn.10461011
Kramer, Anneke ; Stel, Vianda S. ; Caskey, Fergus J. ; Stengel, Benedicte ; Elliott, Robert F. ; Covic, Adrian ; Geue, Claudia ; Cusumano, Ana ; Macleod, Alison M. ; Jager, Kitty J. / Exploring the association between macroeconomic indicators and dialysis mortality. In: Clinical Journal of the American Society of Nephrology. 2012 ; Vol. 7, No. 10. pp. 1655-1663.
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AU - Covic, Adrian

AU - Geue, Claudia

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N2 - Background and objectives Mortality on dialysis varies greatly worldwide, with patient-level factors explaining only a small part of this variation. The aim of this study was to examine the association of national-level macroeconomic indicators with the mortality of incident dialysis populations and explore potential explanations through renal service indicators, incidence of dialysis, and characteristics of the dialysis population. Design, setting, participants, & measurements Aggregated unadjusted survival probabilities were obtained from 22 renal registries worldwide for patients starting dialysis in 2003–2005. General population age and health, macroeconomic indices, and renal service organization data were collected from secondary sources and questionnaires. Linear modeling with log–log transformation of the outcome variable was applied to establish factors associated with survival on dialysis. Results Two-year survival on dialysis ranged from 62.3% in Iceland to 89.8% in Romania. A higher gross domestic product per capita (hazard ratio=1.02 per 1000 US dollar increase), a higher percentage of gross domestic product spent on healthcare (1.10 per percent increase), and a higher intrinsic mortality of the dialysis population (i.e., general population-derived mortality risk of the dialysis population in that country standardized for age and sex; hazard ratio=1.04 per death per 10,000 person years) were associated with a higher mortality of the dialysis population. The incidence of dialysis and renal service indicators were not associated with mortality on dialysis. Conclusions Macroeconomic factors and the intrinsic mortality of the dialysis population are associated with international differences in the mortality on dialysis. Renal service organizational factors and incidence of dialysis seem less important.

AB - Background and objectives Mortality on dialysis varies greatly worldwide, with patient-level factors explaining only a small part of this variation. The aim of this study was to examine the association of national-level macroeconomic indicators with the mortality of incident dialysis populations and explore potential explanations through renal service indicators, incidence of dialysis, and characteristics of the dialysis population. Design, setting, participants, & measurements Aggregated unadjusted survival probabilities were obtained from 22 renal registries worldwide for patients starting dialysis in 2003–2005. General population age and health, macroeconomic indices, and renal service organization data were collected from secondary sources and questionnaires. Linear modeling with log–log transformation of the outcome variable was applied to establish factors associated with survival on dialysis. Results Two-year survival on dialysis ranged from 62.3% in Iceland to 89.8% in Romania. A higher gross domestic product per capita (hazard ratio=1.02 per 1000 US dollar increase), a higher percentage of gross domestic product spent on healthcare (1.10 per percent increase), and a higher intrinsic mortality of the dialysis population (i.e., general population-derived mortality risk of the dialysis population in that country standardized for age and sex; hazard ratio=1.04 per death per 10,000 person years) were associated with a higher mortality of the dialysis population. The incidence of dialysis and renal service indicators were not associated with mortality on dialysis. Conclusions Macroeconomic factors and the intrinsic mortality of the dialysis population are associated with international differences in the mortality on dialysis. Renal service organizational factors and incidence of dialysis seem less important.

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