Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective

Carrero, Juan-Jesús; Hecking, Manfred; Ulasi, Ifeoma; Solá, Laura; Thomas, Bernadette

doi:10.1016/j.semnephrol.2017.02.009

Cited by 76 publications

(51 citation statements)

References 96 publications

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“…The comorbidity of diabetes mellitus results in excess mortality for women among patients on dialysis [16,21]. Women are also reported to receive inferior treatment of anemia and mineral metabolism, and lower dialysis doses than men [22][23][24]. In the current study, we confirmed that women received less pre-dialysis nephrology care, and had higher rates of diabetes and anemia.…”

Section: Discussionsupporting

confidence: 75%

Temporal Trends in Incident Mortality in Dialysis Patients: Focus on Sex and Racial Disparities

et al. 2019

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Background: Racial minorities and women constitute substantial portions of the incident and prevalent end-stage renal disease (ESRD) population in the United States. Although ESRD is characterized by high mortality, temporal trends, and race and sex differences in mortality have not been studied. Methods: We evaluated 944,650 adult patients who initiated dialysis between January 1, 2005 and December 31, 2014, using the United States Renal Data System, for sex-related and race-related trends in mortality. Logistic regression models adjusted for pre-dialysis health status were used to examine associations among the predictors’ sex, race, and year of incident dialysis, and the outcome all-cause mortality at 1-year post ESRD. Results: The mean age was 65 ± 14 years. The 1-year crude mortality rates in incident ESRD patients decreased by 28% from 2004 to 2015. Risk-adjusted 1-year mortality decreased by 3% for each later year of incident ESRD (p < 0.001). In general, from 2005 to 2014, mortality rates decreased across both sexes, and all races. White patients experienced the lowest reduction in adjusted 1-year mortality rates (16%). While women experienced a survival advantage over men in 2005, by 2014 it was reversed to survival advantage for men. Combining all years, the adjusted risk of dying at 1-year after initiating dialysis was lower in women than men (OR 0.98; 95% CI 0.97–0.99), and as compared to whites, was lower in blacks (OR 0.73; 95% CI 0.72–0.74), Hispanics (OR 0.64; 95% CI 0.63–0.65), Asians (OR 0.55; 95% CI 0.53–0.56), and Native Americans (OR 0.67; 95% CI 0.63–0.71). Conclusion: The 1-year mortality rates among patients with ESRD have decreased steadily during a recent 10-year period across both men and women, and in all 5 races. Women have only a 2% lower risk of dying at 1-year after dialysis initiation than men. White patients had higher mortality as compared to other races. Our results suggest the need for sex, and race-specific treatment strategies in ESRD care.

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Section: Discussionsupporting

confidence: 75%

Temporal Trends in Incident Mortality in Dialysis Patients: Focus on Sex and Racial Disparities

et al. 2019

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“…Unfortunately, on the global scale, the projected need for RRT remains two- to fourfold higher than its provision [16]. It is noteworthy that in many countries, a lack of universal health coverage and high out-of-pocket expenses substantially limit women’s access to medical care, due to lower income, thereby resulting in lower solvency [17]. As a consequence, the treatment rate among women is lower compared to men, even in subjects with known CKD (39.6% in women versus 45.5% in men), as was shown in a cross-sectional study performed in 12 low- and middle-income countries [18].…”

Section: Discussionmentioning

confidence: 99%

Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study

Bikbov

Perico

Remuzzi³

2018

Nephron

184

117

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Background: Chronic kidney disease (CKD) imposes a substantial burden on health care systems. There are some especially vulnerable groups with a high CKD burden, one of which is women. We performed an analysis of gender disparities in the prevalence of all CKD stages and renal replacement therapy (defined as impaired kidney function [IKF]) in 195 countries. Methods: We used estimates produced by the Global Burden of Disease (GBD) Study 2016 revision using a Bayesian-regression analytic tool, DisMoD-MR 2.1. Data on gross domestic product based on purchasing power parity per capita (GDP PPP) was obtained via the World Bank International Comparison Program database. To estimate gender disparities, we calculated the male:female all-age prevalence rate ratio for each IKF condition. Results: In 2016, the global number of individuals with IKF reached 752.7 million, including 417.0 million females and 335.7 million males. The most prevalent form of IKF in both groups was albuminuria with preserved glomerular filtration rate. Geospatial analysis shows a very heterogeneous distribution of the male:female ratio for all IKF conditions, with the most prominent contrast found in kidney transplant patients. The median male:female ratio varies substantially according to GDP PPP quintiles; however, countries with different economic states could have similar male:female ratios. A strong correlation of GDP PPP with dialysis-to-transplant ratio was found. Conclusions: The GBD study highlights the prominent gender disparities in CKD prevalence among 195 countries. The nature of these disparities, however, is complex and must be interpreted cautiously taking into account all possible circumstances.

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“…Although rates of chronic conditions in this group were high for both TMBs and CMBs, many chronic conditions that typically occur or worsen in older ages were observed to be even more common among TMBs. [26][27][28][29][30][31][32][33] In this study, we observed that TMBs had higher rates of hypertension, congestive heart failure, coronary artery disease, hyperlipidemia, arthritis, dementia, stroke, Chronic Kidney Disease, and diabetes, compared to their CMB counterparts. The literature on the burden of these types of nonmental health chronic conditions in transgender individuals is very sparse, especially in the United States, and even more so for older transgender adults.…”

Section: Trans Medicare Beneficiaries and Chronic Conditions 407 Discusmentioning

confidence: 95%

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data

et al. 2017

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Purpose: Data on the health and well-being of the transgender population are limited. However, using claims data we can identify transgender Medicare beneficiaries (TMBs) with high confidence. We seek to describe the TMB population and provide comparisons of chronic disease burden between TMBs and cisgender Medicare beneficiaries (CMBs), thus laying a foundation for national level TMB health disparity research. Methods: Using a previously validated claims algorithm based on ICD-9-CM codes relating to transsexualism and gender identity disorder, we identified a cohort of TMBs using Medicare Fee-for-Service (FFS) claims data. We then describe the demographic characteristics and chronic disease burden of TMBs (N = 7454) and CMBs (N = 39,136,229). Results: Compared to CMBs, a greater observed proportion of TMBs are young (under age 65) and Black, although these differences vary by entitlement. Regardless of entitlement, TMBs have more chronic conditions than CMBs, and more TMBs have been diagnosed with asthma, autism spectrum disorder, chronic obstructive pulmonary disease, depression, hepatitis, HIV, schizophrenia, and substance use disorders. TMBs also have higher observed rates of potentially disabling mental health and neurological/chronic pain conditions, as well as obesity and other liver conditions (nonhepatitis), compared to CMBs. Conclusion: This is the first systematic look at chronic disease burden in the transgender population using Medicare FFS claims data. We found that TMBs experience multiple chronic conditions at higher rates than CMBs, regardless of Medicare entitlement. TMBs under age 65 show an already heavy chronic disease burden which will only be exacerbated with age.

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Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective

Cited by 76 publications

References 96 publications

Temporal Trends in Incident Mortality in Dialysis Patients: Focus on Sex and Racial Disparities

Temporal Trends in Incident Mortality in Dialysis Patients: Focus on Sex and Racial Disparities

Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data

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