Abstract
BackgroundThe growing burden of end-stage renal disease (ESRD) has been a great challenge to the health care system of China. However, the exact epidemiological data for ESRD in China remain unclear. We aimed to investigate the epidemiology of ESRD treated by renal replacement therapy (RRT) in Nanjing based on analysing ten-year data of Nanjing three million insurance covered population.MethodsUsing the electronic registry system of Urban Employee Basic Medical Insurance (UEBMI), we included all subjects insured by UEBMI in Nanjing from 2005 to 2014 and identified subjects who developed ESRD and started RRT in this cohort.ResultsThe UEBMI population in Nanjing increased from 1,301,882 in 2005 to 2,921,065 in 2014, among which a total of 5,840 subjects developed ESRD and received RRT. Over the 10-year period, the adjusted incidence rates of RRT in the UEBMI cohort gradually decreased from 289.3pmp in 2005 to 218.8pmp in 2014. However, the adjusted prevalence rate increased steadily from 891.7pmp in 2005 to 1,228.6pmp in 2014. The adjusted annual mortality rate decreased from 138.4 per 1000 patient-years in 2005 to 97.8 per 1000 patient-years in 2014. The long-term survival rate fluctuated over the past decade, with the 1-year survival rate ranging from 85.1% to 91.7%, the 3-year survival rate from 69.9% to 78.3% and the 5-year survival rate from 58% to 65.4%.ConclusionNanjing is facing an increasing burden of ESRD with its improvement of medical reform. The ten-year complete registry data on RRT in urban employees in Nanjing provided a unique opportunity to understand the real threat of ESRD confronting China during its process of health care transition.
Highlights
China experienced an unprecedented process of rapid urbanization over the past decade, which reshaped the nation’s health profile with an increasing burden of non-communicable disease (NCD) [1,2,3]
We aimed to investigate the epidemiology of End-stage renal disease (ESRD) treated by renal replacement therapy (RRT) in Nanjing based on analysing ten-year data of Nanjing three million insurance covered population
Urban residents without employment are covered by Urban Resident Basic Medical Insurance (URBMI) and rural residents are covered by New Cooperative Medical Scheme (NCMS)
Summary
China experienced an unprecedented process of rapid urbanization over the past decade, which reshaped the nation’s health profile with an increasing burden of non-communicable disease (NCD) [1,2,3]. End-stage renal disease (ESRD) is only one of the emerging burdens of NCD, challenging the health care system to provide renal replacement therapy (RRT) to this increasing number of patients [4]. In 2000, the government of Nanjing (the capital city of Jiangsu Province, located in the southeast of China) established an outpatient reimbursement program for RRT (as a part of the Urban Employee Basic Medical Insurance, UEBMI) for all insured urban employees who suffered from ESRD [5]. This reimbursement program of UEBMI covers 90% of the RRT related expenditure, affording all insured ESRD patients access to RRT [5]. We aimed to investigate the epidemiology of ESRD treated by renal replacement therapy (RRT) in Nanjing based on analysing ten-year data of Nanjing three million insurance covered population
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