期刊
KIDNEY MEDICINE
卷 4, 期 7, 页码 -出版社
ELSEVIER
DOI: 10.1016/j.xkme.2022.100485
关键词
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资金
- Taiwan Ministry of Science and Technology (MOST) [106-2314-B-002-253, 107-2314-B-037-122, 108-2314-B-037-110, 105-5R17, 106-6R21, KMUH104-4R09, KMUH105-5R16]
- Kaohsiung Medical University Hospital (KMUH) [105-2314-B-037-065, 104-2314-B-037-073-MY3, 103-3R10, 104-4R11, 103-2314-B-037-033, 104-2314-B-037-054]
- Center for Big Data Research
- National Health Research Institutes [107-2314-B-037-020-MY2, 109-2314-B-037-107-MY2]
- Ministry of Science and Technology [NHRI-EX108-10505PI, NHRI-EX109-10717PI]
The implementation of universal CKD care programs in Taiwan has significantly reduced the long-term trends in the incidence of maintenance dialysis.
Rationale & Objective: Taiwan implemented na-tional pay-for-performance programs for chronic kidney disease (CKD) care in 2006 and 2011; however, it is unknown whether this affected trends in maintenance dialysis. This study assessed the temporal trends in the incidence, prevalence, and mortality of individuals treated with maintenance dialysis from 2002-2016 in Taiwan. Study Design: Follow-up study using Taiwan Renal Disease System Databases. Setting & Participants: Participants who received dialysis for & GE;90 days. Predictors: Age, sex, and calendar year. Outcomes: Incidence, prevalence of maintenance dialysis, or death, ascertained using the National Death Registry database. Analytical Approach: The estimated annual per-centage change was assessed by a generalized linear model, and the association of the programs with changes in the incidence of maintenance dialysis was evaluated using an age-period-cohort model. Results: A total of 144,258 incident cases with a follow-up of 346 million person-years were analyzed during the observed periods. The estimated annual percentage change of the expected crude incidence rate was slightly reduced by 0.41% (95% CI, -1.06 to 0.24) and was more obvious in women and patients aged greater than 70 years; whereas, it was significantly increased in those aged greater than 75 years. After disentangling age and cohort effects, the implementation of the care programs was associated with an overall net drift of -1.09% (95% CI, -1.65 to -0.52) per year and a significant linear reduction in the period rate ratio from 1.06 (95% CI, 1.02-1.09) in the years 2002-2006 to 0.95 (95% CI, 0.92-0.98) in 2012-2016, using years 2007-2011 as reference. Limitations: The findings of the study may have limited inferences to other countries with different health care systems.Conclusions: The implementation of universal CKD care programs in Taiwan has significantly reduced the long-term trends in the incidence of maintenance dialysis; hence, devoting governmental resources to CKD care and prevention is advocated.
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