Abstract
ObjectivesWe aimed to explore the impacts of individual and environmental socioeconomic status (SES) on the outcome of peritoneal dialysis (PD) in regions with significant SES disparity, through a retrospective multicenter cohort in China.MethodsOverall, 2,171 incident patients from seven PD centers were included. Individual SES was evaluated from yearly household income per person and education level. Environmental SES was represented by regional gross domestic product (GDP) per capita and medical resources. Undeveloped regions were defined as those with regional GDP lower than the median. All-cause and cardiovascular death and initial peritonitis were recorded as outcome events.ResultsPoorer PD patients or those who lived in undeveloped areas were younger and less-educated and bore a heavier burden of medical expenses. They had lower hemoglobin and serum albumin at baseline. Low income independently predicted the highest risks for all-cause or cardiovascular death and initial peritonitis compared with medium and high income. The interaction effect between individual education and regional GDP was determined. In undeveloped regions, patients with an elementary school education or lower were at significantly higher risk for all-cause death but not cardiovascular death or initial peritonitis compared with those who attended high school or had a higher diploma. Regional GDP was not associated with any outcome events.ConclusionLow personal income independently influenced all-cause and cardiovascular death, and initial peritonitis in PD patients. Education level predicted all-cause death only for patients in undeveloped regions. For PD patients in these high risk situations, integrated care before dialysis and well-constructed PD training programs might be helpful.
Highlights
The China National Survey of Chronic Kidney Disease Working Group reported that the prevalence of chronic kidney disease was 10.8%, close to that in Western countries [1]
To determine whether individual income or education level interacted with regional gross domestic product (GDP) per capita, we explored their two-way interaction effects on the likelihood of patient survival and peritonitis-free survival
The included 2171 patients had a mean age of 58.0615.5 years and body mass index (BMI) 22.963.6 kg/m2; 37.6% were diabetic and cardiovascular disease (CVD) was present in 40.9% of the subjects at baseline
Summary
The China National Survey of Chronic Kidney Disease Working Group reported that the prevalence of chronic kidney disease was 10.8%, close to that in Western countries [1]. SES has been investigated for its association with the outcomes of treatment in the general population and in patients with chronic kidney disease at the individual [13,14,15,16,17] and environmental [13,15,16,17,18] level. Individual income and education levels vary markedly within regions and probably lead to diverse availability of medical facilities and health-care services. Given this situation, a specific model is needed to determine whether variations in individual or environmental SES influence PD outcome. The interaction between individual and environmental SES on PD outcome, which has never been studied in a dialysis population, should be explored
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